Understanding the patterns of acute treatment of migraine in the population is a necessary step in evaluating treatment in relation to guidelines, and in improving care. Herein we assess the specific medication used for the acute treatment of migraine and chronic migraine (CM) in the population. We identified 24 000 headache sufferers, drawn from over 165 000 individuals representative of the US population. This sample has been followed with annual surveys using validated questionnaires. As part of the survey, subjects were asked to report the specific medications currently used for their most severe headaches, dose, and number of days per month using medication. Complete responses were obtained from 14 540 individuals, including 9128 with episodic migraine and 503 with CM. For episodic migraine, specific treatment was used by 19.2% of subjects (triptans 18.7%; compounds with ergotamine 0.5%). A total of 11.1% routinely used opiates, whereas 6% used compounds with barbiturates. For CM, 22% used migraine-specific treatment, whereas 34.3% used opiates and barbiturates. Non-prescribed medications were frequently used in both groups. Opiates were more commonly used by those with CM [odds ratio (OR) 2.12, 95% confidence interval (CI) 1.69, 2.65], as were butalbital-containing compounds (OR 2.46, 95% CI 1.88, 3.22). The minority of migraineurs in the USA use specific medication, and one-fifth use opiates or barbiturates. For CM, > 34% use opiates or barbiturates. Accordingly, a sizable proportion use medications that are not firstline according to the US Headache Consortium Guidelines.