Almost everybody suffers from a headache once in a while, but if the pain is excruciating and disabling, you could have a migraine. Over-the-counter pain relievers are a good first option for knocking out these severe headaches, but if these don't work, it may be time to reach for a stronger class of medicines called triptans.

Figuring out which one of the very expensive (a single pill can be as much as $43) eight triptan medicines is right for you can be, well, a headache. If you suffer from migraines, you're not alone. These types of headaches are fairly common, afflicting about 30 million U.S. adults. For unknown reasons, they occur three times as often in women than in men. The symptoms include throbbing pain on one or both sides of the head, nausea, vomiting, and sensitivity to movement, light or noise. Before a migraine attack, some people also experience visual disturbances or auras, such as seeing dots or shapes or flickering lights.

Migraines can often be misdiagnosed and some types of migraines should not be treated with triptans. So if you suffer from severe headaches or think you might have migraines, you should see a doctor to get an accurate diagnosis and receive the appropriate treatment.

If diagnosed with migraines, first you may want to reach for nonprescription pain relievers, such as acetaminophen (Tylenol and generics), aspirin, ibuprofen (Advil and generics), naproxen (Aleve and generics), or combination products that contain acetaminophen, aspirin, and caffeine (Excedrin Extra Strength, Excedrin Migraine, and generics).

If those don't work for you, the next step may be a triptan. But which one? Our report considered all of the available evidence for effectiveness, safety, and side effects, as well as cost, and for the Consumer Reports Health Best Buy Drug selection chose:

 Generic sumatriptan tablets, nasal spray, and injectable forms

Sumatriptan is the only triptan available as a less expensive generic, and studies have found that it is as effective as or better than most of the other triptans when it comes to pain relief. At $20 to $24 per tablet, the pill form will save you money over the other brand-name triptans, which cost from $29 to $43 per tablet. The generic sumatriptan nasal spray and injectable formulations are more expensive, but these may be good options for migraine sufferers who experience nausea and vomiting and can't take a tablet.

If sumatriptan doesn't work for you, we recommend trying rizatriptan (Maxalt). Studies indicate it works very well in delivering pain relief within two hours compared with many of the other triptans. But it is more expensive than generic sumatriptan tablets, ranging in cost from $35 to $38 per pill, depending on the dose and formulation.

Overall, the available evidence does not clearly show that one triptan has a superior safety profile or a lower rate of side effects than the others. All of these drugs can cause mild to serious side effects. The most common ones are dizziness, numbness, tingling, flushing, sleepiness, and fatigue. Triptans have been associated with rare cases of heart attacks, life-threatening disturbances of heart rhythm, stroke, and death.

Certain people should not take triptans, including those who have coronary artery disease or angina (chest pain), diabetes, or peripheral vascular disease. People who have had a heart attack or stroke, those who have uncontrolled high blood pressure, and those who smoke should also avoid triptans, as should people who have migraines that are accompanied by weakness or paralysis in an arm or leg, vertigo, ringing in the ears, or speech difficulties.

In addition, triptans should be prescribed with caution for men over 40, women over 50, anyone who has high cholesterol, diabetes, a family history of early heart disease or stroke, and anyone who is significantly overweight.