We often hear that migraine improves with age, but unfortunately that’s not the case for everyone. For some people, migraine continues into older age and is complicated with concerns about medication safety and other comorbidities. For others, new migraine symptoms and headache disorders develop with age. 

Matthew Robbins, MD, addresses some of the challenges of headache and migraine in later life. Dr Robbins is an Associate Professor of Neurology and Residency Program Director at Weill Cornell Medicine, New York Presbyterian Hospital. He is the secretary on the executive board for the American Headache Society, directs all resident education programming and is a resident and fellow section editor of the journal, Headache. 

How does migraine typically change in middle and older age?

Dr. Robbins: Migraine symptoms can change over time. For example, for some older people, a non-headache symptom like aura can occur on its own without a migraine attack, or an aura may be a brand new symptom. When a person was younger, they may have experienced overwhelming symptoms such as nausea and light or sound sensitivity, which may lessen as they age. Older people may have a more general aversion to eat, or just feel queasy, rather than more severe nausea and vomiting. Migraine triggers can also change with age, and once you remove hormonal fluctuations after menopause, it may be possible to pay more attention to other potential triggers.
Are triptans still safe for the older population with migraine?
Dr. Robbins: Triptans as a family of medicine can cause symptoms such as tightness, tingling, and a sense of warmth or discomfort, not just in the chest, but anywhere in the upper body – arms, shoulders, neck, throat, scalp, and face. If someone older develops any of these symptoms for the first time, that should be a cause for an urgent evaluation. People with migraine have more cardiovascular risk factors than people without migraine, so if an older person is having side effects with a certain triptan, there are other medicines within the triptan family that don’t seem to cause those side effects.  The newer medications, such as gepants and other CGRP blockers, activate a different type of serotonin receptor than do triptans and don’t seem to cause that pattern of side effects.
In someone with a history of migraine, what are some factors that might lead to increased frequency of attacks in middle age?
Dr. Robbins: Hormonal changes during perimenopause, the transition time to menopause, can make women more vulnerable to increased migraine frequency, and sometimes that migraine frequency increase remains as they get older. Migraine has a lot of different risk factors for changing from episodic to chronic migraine. As people age, they may experience sleep disturbances or coexisting pain problems that keep the brain overly activated and grease the wheels for migraine attacks to become more frequent. Older people may have musculoskeletal problems such as lower back pain or neck pain that affect migraine frequency.

Watch the full interview for answers to:

What are the most common headache disorders in people over the age of 50?How does migraine typically change in middle and older age?
Is it true that migraine improves with age?
Are triptans still safe for the older population with migraine?
How common is it for an older person to get a new diagnosis of migraine?
In someone with a history of migraine, what are some factors that might lead to increased frequency of attacks in middle age?
What are some alternatives if triptans either stop working for someone, or become unsafe to use?
How safe are some of the typical migraine medications for people older than 50?
Why do some people with migraine become more or less responsive to their usual medications as they age?
What are the risks of a long-term migraine history and the long-term medication use that may accompany it?
Are the newer medications safe for older people with migraine?
What nonmedicinal options exist for migraine after 50 years of age?

Watch Dr. Robbins interview preview here, or order it as part of the Migraine World Summit package from this page.

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