What is the best medication for migraines?

October 7, 2025 •

4 min read

Migraine affects over a billion people worldwide, making it one of the most common neurological conditions [1.8.3]. So, what is the best medication for migraines? The answer depends on the type, frequency, and severity of your attacks.

Quick Summary

The best medication for migraine is individualized. Acute treatments like NSAIDs and triptans stop attacks in progress, while preventive drugs like CGRP inhibitors and beta-blockers reduce their frequency and severity.

Key Points

No Single 'Best' Medication: The ideal migraine medication is highly individual and depends on attack frequency, severity, and personal health factors [1.2.2].
Two Main Treatment Types: Migraine care involves acute medications (like triptans) to stop an attack and preventive medications (like CGRP inhibitors) to reduce their occurrence [1.2.3].
Acute Treatment is Time-Sensitive: Abortive medications such as NSAIDs and triptans are most effective when taken at the first sign of a migraine [1.3.5].
CGRP Inhibitors are a Game-Changer: CGRP inhibitors are the first class of drugs specifically designed to prevent migraines and are now considered a first-line option [1.4.4, 1.4.5].
OTC Caution: Over-the-counter pain relievers can be effective for mild migraines but using them more than 10-15 days a month risks medication-overuse headaches [1.3.5].
Cardiovascular Considerations: Newer drugs like gepants (Ubrelvy, Nurtec) and ditans (Reyvow) are valuable alternatives for patients who cannot take triptans due to cardiovascular risks [1.7.2].
Lifestyle Matters: Combining medication with lifestyle changes like regular sleep, stress management, and trigger avoidance provides the best results [1.10.3].

Understanding Migraine and Why Treatment Isn't One-Size-Fits-All

Migraine is a complex neurological disorder characterized by moderate to severe headaches, often accompanied by symptoms like nausea, vomiting, and sensitivity to light and sound [1.9.2, 1.11.3]. Globally, it's the second leading cause of disability [1.11.4]. The 'best' medication is highly individual and depends on various factors, including the frequency and severity of your headaches, your overall health, and how you respond to different treatments [1.2.2].

Migraine treatments are broadly categorized into two types: acute (or abortive) and preventive [1.2.3]. Acute medications are taken during a migraine attack to stop the symptoms, while preventive medications are taken regularly to reduce the number of attacks and their intensity [1.2.1, 1.2.3].

Acute (Abortive) Medications: For Immediate Relief

Acute treatments are most effective when taken at the first sign of a migraine attack [1.3.5, 1.9.3]. Waiting until the pain is severe can make the medication less effective [1.9.3].

Over-the-Counter (OTC) Options

For mild to moderate migraines, many people find relief with OTC medications [1.9.2, 1.9.4]. These include:

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): Ibuprofen (Advil, Motrin) and naproxen sodium (Aleve) are common choices [1.3.5].
Combination Pain Relievers: Products like Excedrin Migraine, which combine acetaminophen, aspirin, and caffeine, can be effective [1.7.3, 1.9.1].

While accessible, OTC medications should not be used more than 10 to 15 days per month to avoid medication-overuse headaches (MOH), also known as rebound headaches [1.3.5, 1.9.1].

Prescription Acute Medications

When OTC options aren't enough, a doctor may prescribe stronger, more targeted treatments [1.9.2].

Triptans: These are often the first-line prescription treatment for moderate to severe migraine [1.6.2]. They work by increasing levels of the brain chemical serotonin, which helps to constrict blood vessels and block pain pathways [1.11.3]. Examples include sumatriptan (Imitrex), rizatriptan (Maxalt), and zolmitriptan (Zomig) [1.7.1, 1.7.3]. They come in various forms, including tablets, nasal sprays, and injections, offering fast relief [1.3.3, 1.9.4].
Gepants (CGRP Receptor Antagonists): This is a newer class of acute medication that works by blocking a protein called calcitonin gene-related peptide (CGRP), which is released during migraine attacks [1.4.2]. Options include ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT) [1.4.1]. Gepants are a good alternative for those who cannot take triptans due to cardiovascular risk factors, as they do not constrict blood vessels [1.6.3, 1.7.2].
Ditans: Lasmiditan (Reyvow) is another option that targets serotonin receptors but, like gepants, lacks vasoconstrictive effects, making it suitable for patients with cardiovascular concerns [1.7.2].
Ergotamines: These older drugs, such as dihydroergotamine (Migranal), are still used for some patients but are less common now due to side effects like nausea and the availability of newer options [1.7.1, 1.11.3].
New Combination Drugs: In January 2025, the FDA approved Symbravo, a single tablet combining the triptan rizatriptan with the NSAID meloxicam for acute treatment [1.5.1, 1.5.2].

Preventive Medications: Reducing Migraine Frequency

If you experience frequent or debilitating migraines (e.g., more than four headache days a month), your doctor may recommend preventive treatment [1.2.2, 1.9.4]. It can take several weeks to see the full benefit of these medications [1.2.2].

Traditional Preventive Options

Beta-Blockers: Drugs like propranolol and metoprolol, typically used for high blood pressure, are often a first-choice preventive treatment for episodic migraine [1.2.1, 1.2.4].
Antidepressants: Certain antidepressants, such as the tricyclic amitriptyline, are effective in preventing migraines [1.2.1].
Anti-seizure Drugs: Topiramate (Topamax) and divalproex sodium (Depakote) are considered first-line choices for migraine prevention but should not be used during pregnancy [1.2.1].

Newer Preventive Medications: CGRP Inhibitors

The most significant recent advancement in migraine prevention is the class of CGRP inhibitors. These are the first drugs specifically developed to prevent migraines [1.4.5]. They work by blocking the CGRP protein or its receptor [1.4.1]. The American Headache Society now considers CGRP inhibitors a first-line option for prevention [1.4.4].

Monoclonal Antibodies (mAbs): These are self-injected or infused medications taken monthly or quarterly. They include erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality), and eptinezumab (Vyepti) [1.4.4]. They generally have fewer side effects than older preventive medications [1.7.2].
Gepants: Some gepants are also approved for prevention. Atogepant (Qulipta) is a daily oral pill, and rimegepant (Nurtec ODT) can be taken every other day for prevention [1.4.1, 1.4.3].

Comparison of Common Migraine Medication Classes


Medication Class	Type	Primary Use	How it Works	Common Examples	Common Side Effects
NSAIDs	Acute	Mild to moderate pain	Reduces inflammation and pain signals	Ibuprofen, Naproxen, Aspirin	Stomach upset or bleeding [1.7.3]
Triptans	Acute	Moderate to severe pain	Constricts blood vessels, blocks pain pathways	Sumatriptan, Rizatriptan	Tingling, flushing, chest tightness [1.7.1]
Gepants	Acute & Preventive	Moderate to severe pain; prevention	Blocks CGRP protein or its receptor	Ubrelvy, Nurtec ODT, Qulipta	Nausea, drowsiness [1.4.1, 1.7.3]
Beta-Blockers	Preventive	Reduce attack frequency	Lowers blood pressure, mechanism not fully known	Propranolol, Metoprolol	Fatigue, dizziness, depression [1.7.1]
CGRP mAbs	Preventive	Reduce attack frequency	Blocks CGRP protein or its receptor	Aimovig, Ajovy, Emgality	Injection site reactions, constipation [1.4.1, 1.7.1]

Lifestyle and Non-Drug Approaches

Medication is often most effective when combined with lifestyle modifications. Identifying and avoiding personal triggers is key [1.10.2]. Common strategies include:

Maintaining a regular sleep schedule [1.10.4].
Eating regular meals and staying hydrated [1.10.2].
Managing stress through techniques like yoga or meditation [1.10.3, 1.10.4].
Engaging in regular, moderate exercise [1.10.4].
Limiting caffeine and alcohol [1.10.2].

Conclusion

There is no single 'best' medication for migraines; the optimal choice is a personalized one made in consultation with a healthcare provider. Acute treatments like triptans and newer gepants offer relief during an attack, while revolutionary preventive treatments like CGRP inhibitors can significantly reduce the frequency and burden of this debilitating condition. A comprehensive approach that combines the right medication with positive lifestyle changes offers the most effective path to managing migraines.

For more authoritative information, consult the National Institute of Neurological Disorders and Stroke (NINDS) [1.11.3].

Frequently Asked Questions

Acute medication, like triptans or NSAIDs, is taken during a migraine attack to stop pain and other symptoms. Preventive medication, such as beta-blockers or CGRP inhibitors, is taken regularly to reduce the frequency and severity of future attacks [1.2.1, 1.2.3].

CGRP inhibitors are a newer class of medication specifically designed to treat and prevent migraines. They work by blocking the action of a protein called calcitonin gene-related peptide (CGRP), which is involved in causing migraine pain [1.4.5]. They are available as injections, infusions, and oral pills [1.4.1].

Yes, over-the-counter (OTC) medications like ibuprofen, naproxen, or combination products like Excedrin Migraine can be effective for mild to moderate migraines. However, they should not be used more than two to three days a week to prevent medication-overuse headaches [1.2.2, 1.9.1].

Injectable triptans, such as sumatriptan, are among the fastest-acting treatments for acute migraines [1.2.5]. Nasal sprays and orally disintegrating tablets also offer rapid relief compared to standard pills [1.3.3].

Yes. A new combination drug called Symbravo, which contains rizatriptan and meloxicam, was approved in January 2025 for acute migraine treatment [1.5.1, 1.5.2]. Additionally, the class of CGRP inhibitors (gepants and monoclonal antibodies) represents a major recent advancement in both acute and preventive care [1.4.5].

A medication-overuse headache (MOH), also called a 'rebound headache,' is a headache that results from the frequent use of acute pain-relief medication. To prevent MOH, acute medications should generally be limited to a maximum of 2-3 days per week [1.2.2, 1.3.5].

Most acute medications can be used for migraine with aura. However, triptans may not be recommended for certain types of aura, like hemiplegic migraine, or for individuals with a history of stroke or heart disease. It's crucial to consult a doctor for a proper diagnosis and treatment plan [1.7.3].