Migraine After 60: What You Need to Know

Migraine can change as you age, and symptoms may become less frequent or severe. Hormone changes, age-related chronic diseases, and drug interactions might necessitate different treatments to manage migraine after 60. These can include calcitonin gene-related peptide (CGRP) inhibitor medications, nerve blocks, and complementary therapies.

How Many Older Adults Have Migraine?

Most people who have migraine after age 60 have already had attacks throughout their lifetime. However it is possible — though less common — to develop migraine as an older adult.

According to Gretchen Tietjen, MD, a professor emerita of neurology at the University of Toledo in Ohio and an expert in migraine in older adults, people who continue to have migraine later in life are typically those who first developed migraine as a child or teen.

“If people do have migraine that persists into older age, attacks tend to be less frequent and the symptoms are less severe,” says Dr. Tietjen. But there are some people who are older — even into their eighties — who still have regular attacks, she says.

How Does Migraine Change After 60?

Migraine characteristics in older adults can differ from those in younger people.

It’s likely that a combination of factors contribute to migraine triggers, frequency, and symptoms, and those can change as you get older, explains Nina Riggins, MD, PhD, a headache specialist at VA Medical Center in Palo Alto, California.

Triggers

For people in their fifties and sixties, pain, alcohol, and smoking are more likely to bring on an attack.

Symptoms

In addition to migraine symptoms being less severe, they can also be different in people who are older, says Dr. Riggins.

For example, migraine attacks may come without light or sound sensitivity, and there may be fewer cranial autonomic symptoms, such as nasal congestion, ear fullness, ptosis, and tearing of the eye, she says.

“There are also studies that show that migraine [attacks] in older adults have a tendency to be more bilateral (on both sides of the head),” Riggins says. Typically, migraine causes pain on one side of the head.

For Women, Migraine Usually Improves After Menopause

“The best explanation for why more women have migraine than men do is reproductive hormones,” she says. In a normal menstrual cycle, fluctuating levels of estrogen and progesterone can trigger menstrual migraines.

Medication Interactions and Side Effects in Older Adults

For a number of reasons, older adults with migraine should review their migraine prevention and treatment plan with their healthcare provider.

Age-Related Changes

As you get older, the effect of certain medications on your body may change, says Tietjen.

“What might have been an appropriate dose of a medication when you were younger may cause issues later in life because you metabolize it differently. A drug or a certain dose of a drug may not be safe throughout your entire life just because it was safe when you were younger,” she says.

Chronic Disease and Other Risk Factors

“There are now newer treatments that can be a good option if you can’t take these medications,” Tietjen says.

Drug Interactions

Drug interactions are another concern in older adults, who may take several different medications for other chronic conditions besides migraine.

“Medication interactions and side effects are very important to discuss and monitor with older adults,” says Riggins.

If you have multiple health problems, it’s important to coordinate care between your primary care provider and specialists to create a treatment plan that is safe and effective.

Newer Medications May Help Manage Migraine in Older Adults

“CGRP-blocking medications can successfully treat migraine in older adults, when appropriate,” says Riggins. They work by blocking the action of CGRP, a protein in the brain and nervous system involved in the transmission of pain.

• Oral Medications These include drugs called CGRP antagonists, or gepants, such as ubrogepant (Ubrelvy), rimegepant (Nurtec ODT), and atogepant (Qulipta). Ubrelvy treats acute migraine attacks, Qulipta is used preventively, and Nurtec can be used for both.
• Nasal Spray Zavegepant (Zavzpret), another type of gepant, is a nasal spray that can relieve symptoms of a migraine attack. It may be a good option if you experience nausea or vomiting with oral medications.
• Injectable Medications Anti-CGRP mAbs, or monoclonal antibodies, are injections or infusions given once a month or every three months to prevent migraine attacks. Injectable medications include erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality). Eptinezumab (Vyepti) is given as an intravenous infusion.

“These medications are thought to be relatively safe, even in a person who has cardiac disease,” says Tietjen.

Another advantage of the CGRP blockers is that they don’t carry a risk of medication-overuse headache, a type of chronic daily headache caused by overusing acute headache medications, as well as some other drugs.

Other Options for Managing Migraine in People Over 60

Several other treatment types can help manage migraine after 60, including injection procedures, over-the-counter (OTC) pain relief medications, and noninvasive therapies.

Botox and Nerve Blocks

The following procedures for treating migraine can be good options for older adults:

• Botox (Onabotulinumtoxin A) Injections For treating chronic migraine, Botox is injected into the muscles of the forehead and neck at about 30 sites, usually every 12 weeks.

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• Occipital Nerve Block To treat acute migraine pain, a nerve block involves injecting small amounts of a numbing medicine, such as lidocaine, into the base of the skull to block pain signals in the nerves.

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• Sphenopalatine Ganglion (SPG) Block The sphenopalatine ganglion is a group of nerve cells linked to the trigeminal nerve, the main nerve involved in migraine pain. An SPG block numbs the SPG with an anesthetic to reduce pain.

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Other Medications

• Candesartan Some medications that treat high blood pressure, such as candesartan, may also help prevent migraine attacks.

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• OTC Pain Relief Medications OTC medications, such as acetaminophen and NSAIDs (aspirin, naproxen, ibuprofen), can provide temporary relief for migraine pain when other options aren’t available. They are sometimes combined with other migraine medications to increase effectiveness.

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Noninvasive and Complementary Therapies

• Cognitive Behavioral Therapy This is a type of psychotherapy that teaches you how your thoughts and behaviors affect how you perceive pain.
• Neuromodulation This noninvasive treatment involves delivering electrical or magnetic pulses to specific nerves or areas of the brain to prevent or reduce the severity of migraine attacks.
• Biofeedback This relaxation technique uses special equipment to teach you how to monitor and control your physical responses to stress, such as tensing your muscles.
• Stress Management Activities to manage stress, such as breathing exercises, meditation, or yoga, may help reduce the frequency or severity of migraine attacks.
• Acupuncture This treatment involves inserting many thin, disposable needles into specific areas of your skin. Research suggests it may help reduce migraine pain.

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For people of any age, lifestyle measures, such as following a healthy diet and getting regular exercise, can also have a meaningful effect on reducing migraine frequency and severity.

Does Medicare Cover Migraine Treatment?

Migraine treatment can be costly. If you are receiving social security benefits and trying to navigate paying for treatment, see our guide to Medicare coverage for migraine from our partner site, Migraine Again.