Migraine changes with age, with a typical ebb and flow over a lifetime. For most people, it builds in intensity in your 20s and through your 40s, until it crests. Then, in your 50s and onward, things tend to become more tolerable. Headaches gradually become less frequent and intense and more responsive to treatment.
By age 70, only 10% of women and 5% of men have migraine. And yet aging doesn’t guarantee relief for everyone. Even though migraine changes with age, one study found that women aged 60 through 74 were more likely to continue having migraine attacks if they also had a history of depression.
Migraine Changes With Age & Body Differences
What you can count on is that your body will change through the decades. Here are some ways aging can affect your migraine and its treatment.
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Menopause may help migraine. 60% of women experience significantly fewer migraine attacks after menopause; the attacks they do experience tend to be less intense and are manageable with over-the-counter medicines. The theory is that fluctuating estrogen levels during the menstrual cycle serve as a trigger for attacks, so when that cycling ceases, so too does the migraine trigger. (During the hormone swings of perimenopause, however, migraine can temporarily worsen).
Migraine symptoms may change. The light and sound sensitivity that accompanies “typical” attacks tend to disappear. And yet the prevalence of aura also increases with age. People over age 50 are more likely to experience aura without headache (usually visual aura).
Side effects from medications may increase. As we age, many of our body’s systems become less efficient, so the drugs we ingest pack a bigger wallop or linger in our system longer. Our kidneys don’t excrete drugs as well into urine, for example; our liver can’t metabolize drugs as effectively; and the amount of water in our body diminishes, so the medicines in our bodies are more concentrated. Some medications for migraine carry a higher risk of side effects for older people that include confusion, blurred vision and balance problems (such as chlorpromazine, clozapine, and amitriptyline).
Migraine drugs may be more potent. Your usual dosages may have a more powerful effect on your older body. Anti-anxiety drugs that are used to treat migraine can lead to feelings of sedation and confusion. Some beta blockers, also used to treat migraine, might more profoundly lower blood pressure in older people.
Managing Multiple Medical Conditions
Older people tend to take more medications than younger people because they accumulate health problems as they age. This puts the older population more at risk for drug interactions as they treat multiple conditions simultaneously. Some acute migraine medications may not be safe to take because of other conditions, including:
Cardiovascular problems. Triptans cause vasoconstriction. If you have atherosclerosis, your arteries are already narrowed, and taking a triptan could cause restricted blood flow. That’s why doctors usually avoid prescribing triptans for people over the age of 65 or with cardiovascular risk factors. Newer medicines that do not cause vasoconstriction have recently become available (ubrogepant, rimegepant, lasmiditan) and may become more commonly prescribed alternatives.
Liver disease. Acetaminophen (Tylenol) is a common go-to for pain, but is no-go for people with liver disease.
Ulcers. If NSAIDS (like Aleve or Advil) or aspirin are your pain relievers of choice, you may need to be more carefully monitored, as they are more likely to produce side effects such as bleeding ulcers.
Migraine Changes With Age: Safe Migraine Treatment
Update your plan. You and your doctor should review your current medications and medical history to determine the safest updated treatment plan in light of the fact that migraine changes with age. Your doctor may opt to continue with current medications, but adjust the dosage. If you have any new health conditions, your drug plan may also need to change to avoid negative drug interactions. You also may want to consider treatment options that are safe for older people, such as:
- Botox. This is considered the safest migraine preventive option for people with complex medical histories and medication regimens. There are no drug interactions and few, if any, side effects.
- Neuromodulation devices. These external devices (Cefaly, Nerivio, gammaCore, eNeura) alter the activity in the nervous system, and are generally safe in all age groups.
If your migraine disease goes into remission entirely as you hit your later decades, congratulations. For those in whom migraine persists, remember, you have a complex neurological disease — and there are effective treatments for you at any age.