Managing migraine and other headache syndromes in those over 50

Abstract

Migraine in an older person may appear with sensory or motor phenomena ("late-life migraine accompaniments"), so that it may be confused with transient ischemic attack or stroke. An older patient may have cervicogenic headache in addition to migraine. Medication overuse headache is just as much of a problem in older patients as it is in younger ones. Abdominal migraine without headache can be seen in older adults as a migraine equivalent, just as it can occur in children. The most effective drugs for migraine prophylaxis in young people (divalproex, topiramate, metoprolol and propranolol) are similarly effective for those who are over the age of 50. Oral rescue drugs, including naproxen and hydroxyzine, are also useful in older adults. We need to remind older adults about the dangers of excessive use of caffeine in coffee, tea and energy drinks, since these substances can lead to daily HA and migraine equivalents.

Peripheral Nerve Blocks for the Treatment of Headache in Older Adults: A Retrospective Study

“…Furthermore, as comorbid medical illness is common in this population, polypharmacy and drug interactions may cause additional side effects and interfere with the efficacy of both acute and prophylactic headache treatment modalities. Headache pharmacotherapy in the elderly has been the topic of several recent reviews . The evidence for headache pharmacotherapy in the elderly, however, is largely based on anecdotal or expert consensus as this population is rarely included in clinical trials.…”

Migraine in the elderly — diagnosis and treatment: a single-centre experience

“…It is important to underline that other diseases, and headaches that mimic migraine attacks, increase with age, but, at the same time, with age migraine may transform into rebound headaches, medication-overuse headaches, and chronic daily headaches. Factors such as head trauma, hypertension, depression or menopause may be the cause of a symptomatic headache [10]. On the other hand, migraine-afflicted older patients can develop other symptoms at onset, such as scintillating scotoma, migrating paresthesias from the hand to the face, homonymous field defects, or speech disturbances [11,12].…”

Bibliometric Analysis of Research on Migraine-Stroke Association from 2013 to 2023

“…Journal of Pain Research 2023:16 4106 failed to find a higher incidence of high-risk PFOs in the Stoke + MA group, arguing that they were not the primary contributors to the increased risk of MA stroke. 56 In addition, researchers have explored several pathophysiological features of late-life migraine, 115 pediatric migraine, 116 and obstetrics and gynecology migraine. 117 Research on the causes of migraine chronicity and the association of migraine with myocardial infarction, 52 brain white matter lesions, 118 and dementia may also help researchers gain a deeper understanding of the pathophysiological mechanisms underlying migraine.…”