Effective acute treatment of attacks reduces the impact of migraine. Recent studies focus on patient-centered outcomes such as pain freedom, elimination of most bothersome associated symptoms, and return to functioning. Patients may use acute treatments during the premonitory phase or aura, in addition to headaches. Important principles for acute treatment include treating early in the attack, using non-oral and rapid-acting treatment for severe attacks, offering rescue medication as a back-up, and avoiding acute medication overuse. While triptans and analgesics such as nonsteroidal anti-inflammatory drugs are first-line drugs for acute migraine, newer migraine-specific options, including gepants and lasmiditan, are now available. Although several nonspecific medications effectively treat migraine, the use of opioid or barbiturate medications is discouraged. Many therapies effectively treat severe, recurrent attacks, including in outpatient and inpatient settings. Established parenteral therapies include dihydroergotamine, neuroleptics, anti-inflammatory drugs, and anticonvulsants, and treatments for refractory headaches include lidocaine, ketamine, and propofol.