Migraine in Older Adulthood: What Really Changes?

Migraine is often thought of as a condition affecting younger adults, particularly people in their 20s to 40s. However, millions of individuals continue to live with migraine well into their later years. While migraine symptoms may change with age, the condition does not simply disappear for everyone.

In this Migraine World Summit session, headache specialist Dr. Robert P. Cowan, Director of Research in the Headache and Facial Pain Program at Stanford, explains how migraine evolves in older adulthood, why misconceptions about aging and migraine persist, and what patients should understand about treatment, diagnosis, and advocacy as they age.

The key message from this discussion is clear: age alone should never determine the quality of migraine care a patient receives.

The Myth That Migraine Is a Young Person’s Disease

One of the most common misconceptions about migraine is that it is primarily a disease of younger people. While it is true that migraine prevalence peaks during middle adulthood, many individuals continue to experience migraine attacks throughout their lives.

Some people see improvement with age. Research suggests that migraine symptoms may lessen for about two-thirds of women as they grow older, particularly after menopause. Improvements may include:

• Fewer migraine attacks

• Reduced severity

• Shorter attack duration

• Changes in symptom presentation

However, this does not mean migraine disappears entirely. For many people, migraine remains a chronic neurological condition that continues to require treatment and management.

How Migraine Symptoms May Change With Age

Migraine symptoms can evolve over time, and older adults may notice that their attacks look different from the migraines they experienced earlier in life.

Some common changes include:

• Pain that becomes more generalized rather than strictly one-sided

• Reduced sensitivity to light or sound

• Differences in attack duration or intensity

However, these changes do not necessarily mean the condition itself has fundamentally changed.

In some cases, a migraine that becomes more generalized across the head may actually indicate chronic migraine, a condition defined by more than 15 headache days per month, including at least eight migraine days.

This shift in symptoms can sometimes lead to misdiagnosis if physicians assume that generalized pain must indicate a different type of headache.

The Problem of Age Bias in Migraine Care

Another issue older patients may encounter is age-related bias in healthcare.

Some patients report that their symptoms are dismissed simply because of their age. For example, clinicians may assume that an older patient:

• Cannot accurately describe their symptoms

• Is experiencing cognitive decline

• Should expect chronic pain or disability

In some cases, doctors may even speak to family members rather than the patient directly, unintentionally undermining the patient’s autonomy.

Dr. Cowan emphasizes that this behavior is both disrespectful and inappropriate. Every patient—regardless of age—deserves to be treated as a capable decision-maker in their own healthcare.

Patients who feel dismissed should advocate for themselves by clearly describing their symptoms, asking questions, and ensuring their concerns are heard.

Why There Is So Little Research on Migraine in Older Adults

Surprisingly, relatively little research specifically examines migraine in people over 60.

One reason for this gap is how clinical trials are designed. Drug studies often focus on the population most affected by migraine, typically adults between the ages of 20 and 40.

As a result:

• Many trials exclude patients over age 65

• Older adults are underrepresented in research data

• Treatment outcomes for older populations are less clearly documented

Even when older patients are included, the numbers are often too small to analyze separately.

This lack of data does not necessarily mean treatments are ineffective for older adults—it simply means the research has not yet adequately explored the issue.

Age Alone Should Not Limit Migraine Treatment

One of the most important insights from this discussion is that treatment decisions should not be based on age alone.

Instead, doctors should consider each patient’s individual health profile, including:

• Cardiovascular health

• Other medical conditions

• Current medications

• Personal risk factors

For example, some migraine treatments may not be appropriate for patients with cardiovascular disease or stroke risk, but this decision should be based on those specific medical factors rather than age alone.

A healthy 75-year-old may be able to safely use treatments that are often restricted purely because of regulatory guidelines or outdated assumptions.

How Comorbidities Affect Treatment Decisions

Older adults are more likely to have additional medical conditions—known as comorbidities—that may influence migraine treatment choices.

Common considerations include:

• Cardiovascular disease

• Diabetes

• Thyroid disorders

• Medication interactions

• History of stroke or heart attack

For example, traditional migraine medications such as triptans can constrict blood vessels, which may be risky for patients with cardiovascular disease.

In such cases, alternative treatments may be recommended, including:

• Ditans, which work on different serotonin receptors

• CGRP-targeting medications, which appear to have lower cardiovascular risk

• Local treatments such as Botox or nerve blocks

The goal is to match treatment choices to the patient’s full medical profile rather than using a one-size-fits-all approach.

Why Migraine Medications May Stop Working Over Time

Another issue that older patients sometimes experience is that medications that worked for years suddenly become less effective.

Several factors may contribute to this change:

• Altered drug metabolism with aging

• Interactions with newly prescribed medications

• Changes in lifestyle or physical activity

• Emotional stress or life events

• Progression of migraine itself

For example, a patient who begins taking an antidepressant or another medication may unknowingly introduce a drug interaction that affects migraine treatment effectiveness.

Because these interactions can be complex, patients should review all medications with their physician when changes in migraine patterns occur.

The Importance of Routine for Migraine Management

One of the most powerful long-term strategies for managing migraine—at any age—is maintaining consistent daily routines.

The brain of someone with migraine tends to be more sensitive to disruptions in routine, including irregular sleep, skipped meals, or sudden changes in activity.

Helpful habits include:

• Maintaining consistent sleep and wake times

• Eating meals on a predictable schedule

• Exercising regularly

• Avoiding sudden lifestyle changes

Even in retirement, maintaining structure can help stabilize migraine patterns.

The brain interprets sudden changes—such as skipped meals or irregular sleep—as potential stress signals, which can lower the threshold for migraine attacks.

Migraine Management Requires Partnership

Another key takeaway from this session is the importance of collaboration between patients and healthcare providers.

Migraine treatment works best when patients actively participate in decision-making and communicate openly about their experiences.

Patients should feel comfortable asking questions such as:

• Why is this medication being recommended?

• Are there alternative treatments?

• What are the potential risks and benefits?

• How will we measure whether the treatment is working?

This partnership encourages better adherence to treatment plans and ultimately leads to better outcomes.

Preparing for Aging With Migraine

For people currently in their 30s, 40s, or 50s, there are steps that may help support healthier migraine management later in life.

Key strategies include:

• Establishing consistent daily routines

• Maintaining regular physical activity

• Managing stress effectively

• Monitoring migraine patterns over time

• Developing strong communication with healthcare providers

These habits help create stability in the nervous system and may reduce migraine vulnerability over time.

The Future of Migraine Care for Older Adults

Despite the limited research available today, there is growing recognition that migraine in older adults deserves greater attention.

Advances in technology, patient advocacy, and digital health tracking tools are empowering patients to participate more actively in their care.

By bringing better data to clinical conversations—such as migraine tracking apps—patients can help physicians refine treatment strategies and personalize care.

Ultimately, the most important message from this discussion is that migraine does not have an expiration date.

Older adults deserve the same access to effective treatments, informed decision-making, and compassionate care as patients of any other age.