migraine in older adults

Overview

A migraine is a severe headache that can cause throbbing pain, usually on one side of the head. It often comes with nausea, vomiting, and extreme sensitivity to light and sound. Migraine is a brain condition, not just a tension headache.

Migraine is most common in the 30s and 40s. It becomes less frequent as we get older, but many older adults continue to have migraines, and some people develop them for the first time after age 50.

Migraine affects both men and women, but women are more likely to have it. In older adults, other causes of headache become more likely, so a proper diagnosis is important.

Symptoms

Common symptoms

• Throbbing or pulsing headache, often on one side
• Moderate to severe pain that worsens with activity
• Nausea or vomiting
• Sensitivity to light, sound, or smells
• Some people have an 'aura' before the headache, such as flashing lights or tingling

Symptoms in children

• Migraine in children may involve shorter attacks
• They may have abdominal pain, dizziness, or motion sickness
• They may not show typical headache symptoms

Symptoms in older adults

• Headache may be less severe and sometimes affects both sides of the head
• Aura without headache can happen and may be confused with a stroke
• More often accompanied by dizziness, balance problems, or confusion
• Nausea and vomiting may be more intense and can lead to dehydration

Causes

Main causes

• Migraine is thought to involve changes in brain activity and how nerves, blood vessels, and chemicals like serotonin interact.
• Common triggers include stress, lack of sleep, missed meals, certain foods or drinks, weather changes, and bright or flickering lights.
• In older adults, new headache symptoms may sometimes be caused by other health conditions, so a doctor should assess them.

Risk factors

• Being female
• A family history of migraine
• Having had migraine earlier in life
• Long-term stress or anxiety
• Sleep problems such as insomnia
• Some medicines used for heart conditions or blood pressure may trigger headaches in sensitive individuals

When to see a doctor

See a doctor urgently if:

• Seek same-day medical advice if you are over 50 and have a new headache that is unlike anything you have had before.
• See a doctor promptly if your usual headache pattern changes or headaches get worse.
• Get urgent help if you have headache with vision loss, weakness, slurred speech, or a stiff neck.

Book a routine appointment if:

• Make a routine appointment if you have headaches more than once a week, if they interfere with your daily life, or if you need to take painkillers more than two days a week.
• Also speak to your doctor if you have migraine symptoms for the first time after the age of 50.

Diagnosis

A doctor will ask about your headaches, your family history, and lifestyle. They may check your blood pressure and do a basic neurological examination to look at your vision, reflexes, and balance. Keeping a headache diary before your visit can be very helpful.

Tests that may be done

• Blood tests to check for infection, thyroid problems, or other conditions
• An MRI or CT scan of the brain if there are unusual signs or symptoms
• Sometimes an eye examination is advised to check vision and eye health

What to expect at your appointment

Your doctor may ask you to track your headaches for a few weeks. If your headaches are complex, you may be referred to a neurologist or a headache clinic. You will not usually need a scan unless something in your history or examination suggests a possible underlying cause.

Treatment

Treatment for migraine in older adults has two main goals: to stop an attack as it is happening and to prevent attacks from happening as often. Any treatment plan will be tailored to your overall health, other medications you take, and any existing conditions.

Self-care at home

• Rest in a quiet, dark room when an attack starts
• Put a cold or warm cloth on your forehead or neck
• Sip fluids regularly to avoid dehydration
• Try gentle neck and shoulder stretches
• Use relaxation techniques like slow breathing

Medical treatments

Your doctor may recommend medicines to treat a migraine attack when it starts, such as certain painkillers or anti-nausea medications. They may also suggest preventive treatment if attacks are frequent. These can come as tablets, injections, or nasal sprays. Only medicines that are safe for older adults will be chosen, taking your other conditions into account. You should never take another person's headache medicine.

When is surgery considered?

Surgery is not a standard treatment for migraine. This option is rarely considered and only in specific circumstances, under the care of a specialist.

Living with this condition

Living with migraine means learning to manage triggers and knowing what to do when an attack begins. Try to keep a regular routine for sleep, meals, and physical activity. Tell your family and friends about your migraine so they can offer support when needed.

Lifestyle tips

• Keep a headache diary to track triggers and patterns
• Go to bed and wake up at around the same time daily
• Aim to eat regular meals without skipping
• Limit caffeine and alcohol
• Try relaxing activities such as gardening, reading, or gentle yoga

Diet and exercise

Eat a balanced diet with regular mealtimes. Some people find that certain foods trigger attacks, but avoid very restrictive diets unless guided by a health professional. Gentle exercise, such as walking or swimming, can help relieve stress and may reduce the frequency of migraines. Start slowly and stop if a headache begins.

Mental health and emotional wellbeing

Recurring migraines can be exhausting and may lead to worry, frustration, or low mood. Talk with your healthcare team if migraines are making you feel depressed or anxious. If you ever feel overwhelmed or cannot keep yourself safe, call your local emergency number immediately.

Prevention

Migraine cannot always be prevented, but many people can reduce the number of attacks by avoiding triggers, keeping a steady sleep–wake schedule, and using preventive medicines if prescribed.

Vaccines

There is no vaccine for migraine.

Screening programmes

There is no routine screening test for migraine. If you have headaches, your doctor will check for possible causes and decide what, if any, tests are needed.

Complications

If left untreated

• Frequent migraine attacks can make it hard to work, socialize, or care for yourself.
• Using painkillers too often can lead to medication-overuse headache.
• In rare cases, a very long and severe migraine attack may need hospital care.

Long-term outlook

With the right support, most older adults with migraine can manage their symptoms well. Migraine is a long-term condition, but it often becomes less severe or less frequent with age. A doctor can help you find a safe treatment plan that fits your lifestyle and other health needs.

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