Migraines are far more than a bad headache. They are a complex neurological condition affecting over 39 million people in the U.S. — and when an attack hits, the goal is simple: stop it fast and get back to your life. The good news is that today's treatment options are better than ever.
Acute (or "abortive") treatment means medication you take during a migraine attack to stop it — not a daily pill to prevent future ones. The best treatments act quickly, last throughout the day without the headache coming back, and do not leave you feeling wiped out. Because migraines affect everyone differently, finding the right fit often takes some trial and adjustment with your doctor.
Over-the-Counter Options
For milder attacks, common pain relievers can work well when taken early. Ibuprofen (Advil, Motrin), naproxen (Aleve), and the aspirin/acetaminophen/caffeine combination found in Excedrin Migraine all have solid evidence behind them. The key is taking them at the very first sign of an attack — waiting too long reduces how well they work.
One important caution: using pain relievers more than 10–15 days per month can make headaches worse over time, a pattern called medication overuse headache.
Triptans
For moderate-to-severe migraines, triptans have been the go-to prescription treatment for decades — and they remain highly effective. They work by targeting specific receptors in the brain to dial down the migraine response. There are seven available in the U.S. (sumatriptan, rizatriptan, eletriptan, and others), in a variety of forms: pills, nasal sprays, dissolving tablets, and even an injectable option for severe attacks. Triptans can also be used in combination with NSAIDs (Ibuprofen, naproxen, diclofenac, celecoxib) when triptan alone is not effective.
Some triptans last longer in the body, making them useful for migraines that tend to drag on or come back after initial relief.
Triptans are not right for everyone — they are generally avoided by people with heart disease, uncontrolled high blood pressure, or a history of stroke.
Newer Options: CGRP Blockers (Gepants)
These medications block a neuropeptide called CGRP that plays a key role in triggering migraine attacks. Because they do not affect blood vessels the way triptans do, they are a safe option for people who cannot take triptans due to heart or vascular conditions. Three Gepants are FDA-approved for acute treatment:
- Ubrogepant (Ubrelvy) is a tablet taken at the start of an attack.
- Rimegepant (Nurtec ODT) is a dissolving tablet that is uniquely approved for both stopping attacks and preventing them (taken every other day).
- Zavegepant (Zavzpret) is a nasal spray, which is great when nausea is making it hard to keep pills down.
Gepants also appear to be less likely to cause medication overuse headache, which makes them a strong option for people who get frequent migraines.
Lasmiditan (Reyvow)
Lasmiditan works differently from triptans — it targets the brain's pain pathways without constricting blood vessels, making it another option for people with cardiovascular concerns. It can cause dizziness and drowsiness, so you cannot drive for at least 8 hours after taking it.
Dihydroergotamine (DHE)
DHE is one of the oldest migraine treatments still in use — and it deserves more attention than it gets. It works through multiple pathways in the brain and has a long duration of action, meaning migraines are less likely to come back once it kicks in. This makes it particularly useful for attacks that are severe, prolonged, or resistant to other treatments.
DHE is available in several forms: IV infusion (often used in infusion centers for difficult-to-treat attacks), as well as nasal spray options including Trudhesa, a newer formulation approved in 2021, that delivers DHE more effectively through the nose than older versions.
DHE is not for everyone — it should be avoided in pregnancy and in people with heart or blood vessel disease — but in the right patient, it can be a gamechanger.
Butalbital (Fioricet) is a commonly prescribed acute treatment in emergency rooms but its use should be avoided due to high risk of medication overuse headache. Opioids also should not be used in acute treatment.
What is Coming Next?
Migraine research is moving fast, and new treatments are on the horizon. Clinical trials are one of the best ways to access the latest potential therapies and contribute to breakthroughs that will help millions of people.
Chase Medical Research has exciting migraine clinical trials launching soon — reach out to learn more about upcoming opportunities and whether you might be eligible.
