The goals of acute treatment of migraine are cost-effective rapid relief, consistent reduction of disability, and reduced use of rescue medications. Key to acute treatment is matching medication to disability as a surrogate marker for disease severity with a stratified care approach. In the absence of vascular contraindications, triptans are first-line acute treatments for disabling migraine. Acute treatment success can be assessed with use of the paper tool, Migraine-ACT. Opioids and butalbital should be avoided in acute migraine treatment. Triptan type can be selected for patients by differences in speed or effect, formulation, and formulary tier.