For mild or moderate attacks, a combination of aspirin, acetaminophen, and caffeine (Excedrin Migraine and generic) works as well as prescription drugs for many people. Nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, and generic) or naproxen (Aleve and generic) can also be quite effective.
If those drugs don't work, our consultants suggest trying one of the prescription migraine drugs called triptans. They cause fewer side effects than other prescription drugs, and seven are FDA-approved for certain types of migraines. An analysis by Consumer Reports Best Buy Drugs highlights two with notable benefits:
Sumatriptan (Imitrex and generic) is the only triptan available as a generic. It costs $20 to $24 a tablet compared with $29 to $43 a pill for brand-name triptans. Studies show it's as effective as other triptans for controlling migraine pain. Generic sumatriptan is also available as a nasal spray and in an injectable formulation. Those act faster than pills, and can help if migraines are accompanied by vomiting.
Rizatriptan (Maxalt) delivers pain relief within two hours, faster than most other triptans. At $35 to $38 a pill, it's more expensive than generic sumatriptan, but it's a good alternative if sumatriptan doesn't work for you.
Triptans work best at the earliest sign of a migraine. In about a third of migraine sufferers, triptans don't work reliably. Try several to see which is best for you. They might work better if taken with other NSAIDs. All triptans can cause troubling side effects, including dizziness, fatigue, flushing, numbness, and tingling. And they have been linked to rare cases of heart attacks, lifethreatening disturbances of heart rhythm, strokes, and death. Don't use them if you're obese, you smoke, have coronary artery disease, diabetes, peripheral vascular disease, or a history of heart attack or stroke.
Combination drugs containing butalbital (Fioricet, Fiorinal, and generic) lack clinical trial evidence for effectiveness against migraines and might lead to dependence and overuse. Opioids cause nausea, drowsiness, and constipation, and frequent use can lead to dependence and medication-overuse headaches. If you don't respond to triptans or can't tolerate them, consider opioids.