Migraine in the Elderly: Symptoms, Treatment and Prevention

• Occurrences of migraines tend to decrease as the body enters old age due to a drop in associated hormone production, although they can still make an appearance at an advanced age. 
• Diagnosis and treatment for geriatric migraines can be a complicated process because of medication taken to manage other congenital health conditions. Additionally, elderly patients must also be wary of headaches resulting from a variety of other, more serious health disorders, such as meningitis, cancer or stroke. 

Migraines naturally reduce in number as we reach old age due to a drop in production of certain types of hormones, although this doesn’t mean that migraines cannot still affect geriatric patients. Crucially, diagnosis and treatment for elderly migraine sufferers can be a difficult process because some drugs used to manage health conditions can complicate the issue, as can the presence of other, more serious illnesses such as meningitis, cancer and stroke. 

Migraines occur due to abnormalities affecting the nervous system in the cortical layer of the brain, leaving the brains of migraine sufferers more prone to stimulation than others. Irregularities in chemical production cause blood vessels to swell and expand, resulting in a severe headache. 

A number of factors can stimulate the onset of migraine headaches: stress, a lack of rest, exposure to certain smells or fumes, sunlight, particularly hot or cold weather conditions, and certain foods and drinks such as pickled products, cheese and wine. Patients should avoid those which they observe to be problematic. 

Furthermore, should patients not receive timely treatment for their condition, the brain will adjust to the pain by increasing the severity and frequency of the migraines, eventually causing a resistance to pain killing medication. 

The most common symptoms of a migraine headache are: 

• The main symptom is a severe throbbing headache that throbs in time with the contraction of blood vessels. 
• Migraines usually affect just one side of the head, although they can occur on both sides. 
• The pain tends to increase in severity when performing certain actions, including walking, ascending stairs and bending over or leaning down. 
• Sufferers may experience pain that is partly relieved by resting in a cool, dark space. 
• Migraines, if not properly diagnosed and treated, will worsen over a period of 4–72 hours. 
• Sufferers may experience nausea or vomiting alongside a painful headache. 
• There may also be vision issues including distortion, the appearance of floaters, flashing and excessive brightness. 
• Sufferers may experience a headache that is easily stimulated from exposure to certain smells such as paint or perfume. 

• A headache that comes on suddenly and severely in patients with no prior history of the condition. 
• Migraines that only begin after the patient reaches the age of 50. 
• A migraine that worsens in terms of its severity and duration. 
• A fever, dizziness and vomiting. 
• Symptoms that are not relieved despite taking pain killing medication. 
• Exhaustion, severe leg and arm weakness, a drooping mouth, difficulty speaking and vision irregularities. 
• A headache affecting a geriatric patient with a congenital health condition, including cancer, diabetes, a physical disability or high blood pressure. 

Elderly patients should seek urgent medical attention where any of the aforementioned symptoms present themselves, as they could signify a number of conditions that are more serious than a migraine, including meningitis, stroke or brain tumor. All of these conditions require urgent diagnosis that includes a range of additional screening techniques, such as a blood test, cerebral spinal fluid (CSF) assessment, CT scan or MRI scan. 

Diagnosis by medical staff begins with a full body check-up and inquiries into the patient’s headache history. If they detect an irregularity combined with vision issues and a family history of migraines or chronic headaches, the medical staff may send the patient to undergo an MRI scan. This enables detection of problems associated with the blood vessels of the brain, which is especially crucial in cases where the patient experiences their first migraine after the age of 50. Because this is an uncommon occurrence, the additional screening is necessary in order to make an accurate diagnosis. 

There are 2 main objectives when providing treatment for migraines: 

1. Treating the acute symptoms that present themselves during a migraine, with best results coming from pain relief drugs such as paracetamol, NSAIDs and other medication focused directly on the brain’s blood vessels, including triptan and ergotamine. 
2. Preventing recurrence of migraines, which usually involves a daily dosage of medication including: 
   • Anticonvulsants 
   • Blood pressure medication 
     • Calcium channel blockers 
     • Beta blockers 
   • Anxiolytics that can provide relief for some forms of migraine 

• Take good care of your health and eat a healthy, high fiber, balanced diet. 
• Exercise regularly but at low intensity, or as directed by your physician. 
• Do not, under any circumstances, buy your own pain relief medication or any other drugs unless advised to do so by your physician. 
• Consult your physician any time you experience an irregularity or when suffering from a severe, acute headache. 

Migraines in geriatric patients are nowhere near as common as in members of the younger population, but they can pose a significant worry to the elderly due to complications arising from their treatment. Such issues are often a result of other underlying health conditions, so should a geriatric patient experience a severe headache or migraine that affects their daily life, they are advised to seek medical attention for proper diagnosis and treatment. Under no circumstances should these patients choose their own medication over the counter as this could pose serious health risks.