Episodic Migraine and Older Adults

Abstract

Purpose of Review Migraine is and continues to be a significant medical issue in older adults. Migraine can have different characteristics in older adults and specific diagnostic and treatment considerations need to be applied when managing headache and migraine in this population, which is increasing in both size and diversity. Contrary to widely held beliefs, migraine may not improve in older women following menopause and can have new onset in older age. The purpose of this review is to give an update on the diagnosis and treatment of episodic migraine in older adults. Recent Findings As the population ages, migraine in older adults will become a more significant public health issue. Migraine in older adults can present with different clinical symptoms than in a younger population and is primarily a diagnosis of exclusion in older adults. Migraine treatment considerations for older adults should include comorbidities and medication interactions. Recent findings suggest there are medications that should be avoided when treating seniors with migraine. Summary The purpose of this review is to give an update on the most important aspects regarding the diagnosis and treatment of headache and migraine in older adults. In addition, recommendations will be made concerning medications that need careful consideration when prescribing to seniors.

Questionnaire-Based Survey during COVID-19 Vaccination on the Prevalence of Elderly’s Migraine, Chronic Daily Headache, and Medication-Overuse Headache in One Japanese City—Itoigawa Hisui Study

“…Indeed, migraine is most active between the third and fourth decades of life with the majority of elderly chronic migraine patients indicating an onset of migraine prior to 50 years. Importantly, given the worldwide increase in life expectancy, older age migraine is likely to become a far greater personal and public health issue over the next 40 years as management is likely to be confounded by other health problems and consequent association with polypharmacy [ 13 , 36 ].…”

Role of endocrine PACAP in age-related diseases

“…As the population ages, headaches in elderly are likely to become a more significant public health issue. The prevalence of chronic headaches, including chronic migraine, chronic tension type headaches, medication overuse headaches in the elderly ranges from 5 to 22% and occurs more frequently in women ( 39 – 41 ).…”

Ultrasound‐guided stellate ganglion block for the treatment of migraine in elderly patients: A retrospective and observational study

“…1 In this population, the diagnosis of migraine first requires the exclusion of secondary headaches, as the prevalence and incidence of secondary headaches increases with age, and second, it is important to note that the symptoms are less likely typical, more bilateral, less sensitive to light and sound, and less cranial autonomic in origin. [2][3][4] As the global population ages, the absolute number of aging patients with migraine is also relatively large; therefore, more elderly patients with migraine seek medical assistance, posing a considerable burden on individual and public health. 5 Acute and preventive drug therapy remains the primary means of managing elderly patients with migraine 1 ; however, these medications should be used with caution in the elderly, as age-related medication side-effects need to be considered.…”

“…Finally, 41 patients completed the 3-month follow-up, with a total of 14/52 (27%) patients being unsatisfied with treatment effect. The patients received a mean (SD, range) of 3.4 (1.5, 1-8) SGB treatments, with a median (IQR) interval of 3 (2)(3)(4)(5) days between treatments and a median (IQR) total treatment period of 4 (2-5) weeks. Alternating bilateral SGBs were performed in 69% (36/52) of the patients with bilateral headache attacks, while unilateral SGBs were performed in 31% (16/52) with unilateral headache attacks (Table 1).…”

“…Generally, elderly individuals with migraine have different clinical features compared to younger patients with migraine 1 . In this population, the diagnosis of migraine first requires the exclusion of secondary headaches, as the prevalence and incidence of secondary headaches increases with age, and second, it is important to note that the symptoms are less likely typical, more bilateral, less sensitive to light and sound, and less cranial autonomic in origin 2–4 . As the global population ages, the absolute number of aging patients with migraine is also relatively large; therefore, more elderly patients with migraine seek medical assistance, posing a considerable burden on individual and public health 5 …”