Understanding What Is the Best Painkiller for Migraines

October 11, 2025 •

4 min read

According to the American Migraine Foundation, over 39 million Americans suffer from migraines, and finding effective relief can be a significant challenge. The search for what is the best painkiller for migraines is a highly personal journey, as treatment success depends on the severity of the attack, individual response, and potential side effects.

Quick Summary

The ideal painkiller for a migraine attack depends on its intensity and individual patient factors. Options range from simple NSAIDs for mild cases to targeted prescription drugs like triptans and newer CGRP antagonists for more severe episodes.

Key Points

Personalized Treatment: The best painkiller for migraines is highly individual and depends on attack severity, personal medical history, and response to treatment.
Start with OTCs for Mild Migraines: For mild to moderate attacks, NSAIDs like ibuprofen or naproxen and combination products (e.g., Excedrin Migraine) are often effective, especially when taken early.
Triptans are a First-Line Prescription: Triptans are typically the first choice for moderate to severe migraines in patients without vascular disease, offering various fast-acting delivery methods.
Gepants Offer a Non-Vasoconstrictive Option: Newer CGRP antagonists, or gepants, provide an alternative for patients who cannot use triptans due to cardiovascular risks, blocking a specific pain pathway.
Preventive Medication for Frequent Attacks: For frequent or chronic migraines, a doctor may prescribe preventive medications, such as beta-blockers or CGRP monoclonal antibodies, to reduce frequency.
Avoid Overuse Headaches: Limiting the use of acute painkillers is crucial, as overuse can lead to medication-overuse headaches, worsening the problem over time.
Consult a Healthcare Provider: Always consult with a doctor to discuss your options, especially before trying new medications, to ensure safety and effectiveness.

Navigating Migraine Pain Relief

Choosing the right medication to treat a migraine attack is a crucial step toward effective pain management. What works best for one person may not be right for another, making it important to understand the different classes of medication available and to work with a healthcare provider to find the most suitable option. Treatments can be broadly categorized into acute, or abortive, treatments that stop a migraine in progress, and preventive medications taken regularly to reduce the frequency and severity of attacks.

Over-the-Counter (OTC) Pain Relief

For individuals with mild to moderate migraine pain, over-the-counter medications are often the first line of defense and can be quite effective, especially when taken early in an attack.

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): These medications, such as ibuprofen (Advil Migraine) and naproxen sodium (Aleve), work by reducing inflammation and blocking pain signals. They are most effective when taken right at the onset of symptoms.
Combination Pain Relievers: Products like Excedrin Migraine combine aspirin, acetaminophen, and caffeine. The caffeine acts as an amplifier, boosting the pain-relieving effects of the other ingredients. These can be helpful for milder attacks but may not be sufficient for severe ones.
Caution with OTCs: Overusing any pain reliever, including OTC options, can lead to medication-overuse headaches (MOH), a condition where the medication itself causes more frequent headaches. It is generally recommended to limit these medications to no more than two or three times per week.

Prescription Acute Migraine Treatments

For those with more severe migraines or those for whom OTC options are ineffective, targeted prescription medications are the standard of care.

Triptans: Considered the gold standard for moderate to severe migraines, triptans (e.g., sumatriptan, rizatriptan, eletriptan) are serotonin receptor agonists. They work by constricting blood vessels and blocking pain pathways in the brain. Triptans are available in various forms, including oral tablets, nasal sprays, and injections, offering different onset speeds. However, they are not suitable for individuals with a history of heart disease, stroke, or uncontrolled hypertension due to their vasoconstrictive effects.
Gepants (CGRP Antagonists): This is a newer class of medication approved for acute treatment. Oral gepants like ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT), and the intranasal spray zavegepant (Zavzpret), block the calcitonin gene-related peptide (CGRP) pathway involved in migraine pain. A key advantage of gepants is that they do not cause vasoconstriction, making them a safe alternative for patients with cardiovascular risk factors.
Ditans (Lasmiditan): Lasmiditan (Reyvow) is a selective serotonin agonist that works on a different receptor subtype (5-HT1F) than triptans. This means it effectively treats migraine pain without causing blood vessel constriction, another viable option for patients with cardiovascular concerns.
Ergots: Medications like dihydroergotamine (DHE) are a class of older drugs that can be effective for some individuals, particularly those with prolonged or difficult-to-treat migraines. They are available as a nasal spray or injection but are generally used less often now than triptans due to lower efficacy and more side effects.
Antiemetics: If a migraine is accompanied by severe nausea or vomiting, a doctor may prescribe anti-nausea medications like metoclopramide or prochlorperazine. These can be taken with painkillers to help with absorption and relieve symptoms.

Comparison of Acute Migraine Treatments

To illustrate the differences, consider this comparison of major acute migraine treatment classes:


Feature	NSAIDs (Ibuprofen, Naproxen)	Triptans (Sumatriptan, Rizatriptan)	Gepants (Ubrogepant, Rimegepant)	Ditans (Lasmiditan)	Ergots (Dihydroergotamine)
Best for	Mild to moderate pain	Moderate to severe pain (no cardiovascular risk)	Moderate to severe pain (with or without cardiovascular risk)	Moderate to severe pain (with or without cardiovascular risk)	Prolonged or refractory migraines
Mechanism	Reduces inflammation via prostaglandin inhibition	Constricts blood vessels, blocks pain pathways	Blocks CGRP pathway	Selectively acts on 5-HT1F receptor, blocks pain	Constricts blood vessels
Speed of Action	Varies; faster with effervescent forms	Varies by formulation; injections are fastest	Onset can be ~15-60 minutes	Variable onset	Effective shortly after onset, especially for long migraines
Side Effects	GI upset, bleeding, potential for MOH	Chest tightness, tingling, dizziness	Nausea, fatigue, dry mouth (generally well tolerated)	Dizziness, sedation; impairs driving for 8 hours	Nausea, vomiting; vasoconstrictive effects
Delivery	Oral tablet, liquid gel	Oral tablet, nasal spray, injection, dissolvable wafer	Oral tablet (including ODT), nasal spray	Oral tablet	Nasal spray, injection

Finding the Right Solution for You

The best painkiller for migraines is the one that works for you. Finding this solution often requires a process of trial and error under medical supervision. Your doctor will consider the frequency and severity of your attacks, your other health conditions, and your response to different treatments. Keeping a headache diary can be immensely helpful, as it provides your doctor with valuable information about your migraine patterns and medication effectiveness.

Conclusion

There is no single best painkiller for migraines that suits every person. The most effective approach involves a personalized strategy, starting with over-the-counter options for milder cases and progressing to targeted prescription medications like triptans, gepants, or ditans for more severe attacks. Newer treatments, especially CGRP antagonists, offer safer alternatives for individuals with cardiovascular concerns. For the best outcome, it is essential to work closely with a healthcare professional to identify your specific triggers and develop a comprehensive treatment plan. This may also include incorporating preventive medications and lifestyle adjustments like stress management and regular exercise.

Frequently Asked Questions

Yes, over-the-counter painkillers like ibuprofen, naproxen, and combination products like Excedrin Migraine can be effective for mild to moderate migraines, particularly if taken as soon as symptoms begin.

Triptans are a class of prescription medications that target serotonin receptors in the brain. They work by constricting blood vessels and blocking pain pathways to provide relief from moderate to severe migraines.

No, triptans are contraindicated for individuals with a history of heart disease, stroke, or uncontrolled high blood pressure due to their vasoconstrictive effects. Newer options like gepants are safer alternatives.

Gepants are a newer class of CGRP antagonists, such as rimegepant and ubrogepant, that block the CGRP pain pathway without causing blood vessel constriction. They are a valuable alternative for patients who cannot take triptans or those with cardiovascular risk.

A medication-overuse headache is caused by the frequent and long-term use of acute pain medications for migraines. Limiting acute treatments to no more than two or three times per week can help prevent this.

If you experience nausea or vomiting with your migraines, anti-nausea medications (antiemetics) can be taken with your painkiller. They can also help improve the absorption of oral tablets.

A migraine diary is a helpful tool for tracking your symptoms, triggers, and the effectiveness of your medication. This information can assist your healthcare provider in developing the best possible treatment strategy for you.