Elderly People Suffer Migraine Too
Migraine is most common in younger people, with a peak around puberty. As a result, there is a perception that it is a problem that doesn’t really affect the elderly. However, a new review makes clear that, while it is less common in the older population, those over the age of 60 years of age also suffer.The review focused on those over the age of 60 and revealed headache is less common in elderly migraine sufferers, with only the visual (aura) elements of migraine experienced. People who experience migraine headache for the first time over the age of 60 are likely to have another underlying medical problem that should be investigated.It also made highlighted there are specific issues that need to be considered with respect to other health issues that come with ageing which, in turn, affect treatment choices. In addition, while migraine is also linked to other conditions, some of these are of particular importance to elderly sufferers, such as stroke, depression, vertigo and epilepsy. Some of these, such as depression, can have an impact on migraine itself, while others also impact on treatment choices that can be made to relieve migraine.The authors offer the following guidance:
- analgesics – paracetamol can be used for acute attacks, with aspirin used with caution because of the risks of stomach bleeding. Non-steroidal anti-inflammatory drugs, such as ibuprofen and diclofenac, should be used with caution, if at all, in elderly people. Opioids, such as codeine, should also be used with caution as they cause drowsiness and other side effects; if used the dose should start low and increase slowly
- anti-emetics – drugs such as metoclopramide increase the risk of certain side effects, called extrapyramidal side effects
- ergotamine – should be avoided or used with caution as can cause side effects
- triptans – can be used but screening for heart problems is advised as these drugs can cause cardiac side effects
- tricyclic antidepressants – caution is advised, although the doses used for migraine are lower than the doses used for treating depression so there is less likelihood of side effects
- beta-blockers – their use may be limited as they influence other medical problems and the dosage of propranolol needs to be altered
- sodium valproate – side effects are more common in the elderly
- topiramate – high risk of side effects in any age group
- lisinopril and candesartan – should be used with caution as can cause kidney problems
- calcium channel blockers – dosage needs to b adjusted and side effects more common.
Haan J, Hollander J, Ferrari MD. Migraine in the elderly: a review. Cephalalgia, 2006. doi:10.1111/j.1468-2982.2006.01250.x
What the WHA thinks
- A useful review for an under-recognised group of migraine sufferers
The information on co-morbid conditions and the impact of age on treatment choices is particularly valuable.