Chapter 7, Episode 2: Migraine in Older Adults
TRANSCRIPT
This content has been medically reviewed by Dr. Nina Riggins.
Migraine can change over a person’s lifetime and may become more difficult to manage with age. About 10% of older adults experience migraine, during a time when new health conditions often occur, and some treatments may become less safe.1
Migraine in older adults may also present differently compared to younger people. You might experience attacks that cause pain on both sides of your head, new visual aura symptoms, or even aura without any head pain.1,2
Before your clinician treats you for migraine, they will rule out secondary headaches.1 These are caused by underlying medical conditions and are more common in older adults. If you notice a new headache or changes in your usual pattern, that could be a sign of a secondary headache and would require evaluation from a clinician.
Once secondary causes are ruled out, your clinician will evaluate many factors as they create your migraine treatment plan. As you age, your body may process medications differently. Changes in the liver, kidneys, and heart, as well as other health conditions, can affect which treatments are safe. Sensitivity to medications may increase, and side effects may become more noticeable.
For older adults, certain migraine treatments may need to be avoided, adjusted, or used cautiously, particularly if they interact with other medications. Some providers recommend starting with lower doses and increasing gradually, which can be effective for disease control while minimizing side effects.
While there are many treatment options for older adults, some acute and preventive therapies tend to have fewer side effects or contraindications. Acute treatment options may include gepants, neuromodulation devices, or nerve blocks. Preventive options may include supplements such as magnesium or riboflavin, candesartan, gepants, CGRP monoclonal antibodies, onabotulinumtoxinA, neuromodulation devices, or behavioral therapies.
Other treatments may also be considered, and your clinician can help determine the safest and most effective approach.
Preventing medication overuse headache is also important.* It can occur when certain medications are used too frequently. Taking acetaminophen or NSAIDs more than 14 days a month, or triptans, ergots, opioids, and combination medications more than nine days a month, increases the risk.3
Since migraine and comorbid health conditions can change over time, be sure to check in with your clinician regularly.
With the right diagnosis and treatment plan, migraine can be managed safely at any age.
For more information, visit migrainedisorders.org.
Additional resource: https://www.migrainedisorders.org/migraine-in-older-adults/
*Also known as medication adaptation headache.
References
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9007780/
- https://headachejournal.onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2006.00343.x
- https://ichd-3.org/8-headache-attributed-to-a-substance-or-its-withdrawal/8-2-medication-overuse-headache-moh/
*The contents of this video are intended for general informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. AMD does not recommend or endorse any treatment, products, or procedures mentioned. Reliance on any information provided by this content is solely at your own risk.