Manage migraines with first-line over-the-counter treatments like acetaminophen-aspirin-caffeine combinations or NSAIDs (e.g., ibuprofen) for acute relief, as recommended by leading guidelines. If these fail, doctors may prescribe triptans (e.g., sumatriptan) or newer CGRP inhibitors (e.g., rimegepant). Frequent migraines may require preventive strategies, including beta-blockers or anticonvulsants, with further evaluation for persistent or severe cases.
January 14, 2025

Migraines: Best OTC Medications Doctors Recommend

Evidence-Based Over-The-Counter Guide

William Shen

William Shen

Co-founder & CPO

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This guide is based on a widely-cited 2021 medical review published in the Journal of the American Medical Association. 

Migraines are recurring headaches with moderate to severe intensity, often accompanied by nausea, vomiting, or sensitivity to light and sound. Treatment focuses on aborting acute attacks and preventing future episodes.

When does a new headache need evaluation with imaging like MRI or CT?

  • Sudden, severe onset (“thunderclap headache”).

  • Neurologic signs (e.g., weakness, numbness, vision changes).

  • Age ≥50 years with new headache symptoms.

  • Comorbidities like cancer or immunosuppression.

  • Red flag symptoms: Headaches triggered by physical activity or postural changes.

Doctor’s first choice for acute migraine attacks:

  • Acetaminophen-aspirin-caffeine: 250 mg-250 mg-65 mg tablet; 2 tablets PO every 6 hours as needed. Do not exceed daily dose limit on medication label. Excedrin Migraine Relief Combo Caplets (FDA M013). 

  • NSAIDs: Effective for mild to moderate migraines. Ibuprofen: 200-400 mg orally every 6-8 hours as needed. Do not exceed daily dose limit on medication label. Advil Migraine Pain Reliever Gelcaps (FDA N021472). 

Prescription medications if OTC fails: 

  • Triptans: First-line for moderate to severe migraines (e.g., sumatriptan, rizatriptan). Avoid triptans if you have coronary artery disease, stroke, or peripheral artery disease or uncontrolled or multiple cardiovascular risk factors.

  • Gepants (eg. Rimegepant, Ubrogepant): A newer class of medication that inhibits calcitonin gene-related peptide (CGRP) and can be highly effective in reducing the pain and symptoms associated with migraines

  • Preventive medications: Beta-blockers, anticonvulsants, or CGRP inhibitors for frequent migraines. Preventive treatments typically require a trial of ≥6 weeks to assess effectiveness.

Citations:

Friedman, B. W. (2017). Managing migraine. Annals of emergency medicine, 69(2), 202-207.

Mayans L, Walling A. Acute Migraine Headache: Treatment Strategies. Am Fam Physician. 2018; 97(4): p.243-251. pmid: 29671521.

Robbins MS. Diagnosis and Management of Headache: A Review. JAMA. 2021 May 11;325(18):1874-1885. doi: 10.1001/jama.2021.1640. PMID: 33974014.

What OTC evidence is reviewed?

  • For each condition, we performed a literature review to find a recent widely cited expert group guideline published in the leading specialty-specific peer-reviewed journal or top general medical journal.

  • Based on the recommendations in the publication, we identify recommended active ingredients and devices that are available over-the-counter per FDA regulations.

What evidence is prioritized?

Levels of evidence considered:

  • Tier 1 (Safe and Definitely Effective): Professional field consensus or multiple randomized controlled clinical trials showing the same conclusion. Wherever possible, we use Tier 1 evidence for "first-line" recommendations.

  • Tier 2 (Safe and Probably Effective): Individual clinical trials which may be discordant or large-scale observational experience. Tier 2 evidence may inform "first-line", "second-line", or "supplement" recommendations.

  • Tier 3 (Safe and Maybe Effective): Mechanistic plausibility without high-quality clinical evidence of efficacy but high-quality evidence of safety. Tier 3 evidence may inform "second-line" or "supplement" recommendations.

How does MDandMe select recommended products?

  • Based on the top clinical recommendation, we evaluate products containing the recommended active agent with FDA-approved dosage based on price, average customer reviews, how often it is purchased, and how quickly it will ship to home. 

  • We provide public documentation of the active ingredients in our recommendations, using all 32 FDA monographs, Prescription-to-Nonprescription (Rx-to-OTC) Switches, as well as New Drug Application (NDA) approvals.

How does MDandMe select recommended devices?

  • Based on the top clinical recommendation, we evaluate devices that are FDA-cleared or comply with other medical guidelines (if not a FDA-regulated category) by reputability, price, and average customer reviews.

  • We provide public documentation of supporting evidence for each device.  

Where do I view other OTC guides?

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You can view all of our published OTC guides here.

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