Migraine and new headaches in older adults: what changes after 50 and 65

The NHS describes migraine as a condition with a throbbing headache, often on one side and worse on movement, nausea or vomiting, and sensitivity to light and sound. Some people have an early phase with tiredness, yawning, food cravings, mood change, stiff neck or passing more urine, and some have aura, such as zigzag lines or flashing lights, pins and needles, dizziness or difficulty speaking, which should not last longer than 1 hour. Attacks usually last between 4 hours and 3 days.

The Migraine Trust lists several types, including migraine with and without aura, chronic migraine (headache on at least 15 days a month), vestibular migraine in which vertigo, dizziness or unsteadiness are often the main symptoms, hemiplegic migraine with temporary weakness on one side, and medication overuse headache. Vestibular migraine is worth knowing about in later life, when dizziness may otherwise be assumed to be an inner ear or blood pressure problem.

The Migraine Trust explains that attacks in later life usually occur in people who are predisposed and who probably had migraine earlier, for example in childhood or early adulthood, then a long quiet spell. Lifestyle changes, increased stress or hormonal changes may bring attacks back or make them worse. Others find migraine improves or goes away. If migraine has become worse or more frequent with no clear reason, the charity says to speak to your doctor.

For women, it says that around perimenopause and menopause attacks can change pattern, improve or increase, and for most women they settle two to five years after the menopause. After the menopause other triggers may become more obvious, such as neck tension. Hot flushes, night sweats and disturbed sleep can make attacks more likely.

The Migraine Trust says people who experience migraine for the first time in later life should talk to their doctor, who can do a health check to rule out other conditions. A change in the pattern of headaches, particularly worsening or unusual symptoms, should always be checked with a doctor, according to its diagnosis page, which also says there is no test that diagnoses migraine; scans help rule out other causes but cannot diagnose migraine, so diagnosis depends on history and examination, and a diary of attacks helps.

The NHS lists temporal arteritis (giant cell arteritis) as a serious condition in which arteries at the temples become inflamed, with frequent severe headaches, pain or tenderness at the temples or scalp, jaw pain when eating or talking, and vision problems such as double vision or loss of vision in one or both eyes; it also mentions flu-like symptoms, weight loss, depression and tiredness, and a link with polymyalgia rheumatica. It says to ask for an urgent GP appointment or NHS 111 if you think you might have it, because it can lead to stroke and blindness if not treated quickly, and that steroid treatment is usually started before the diagnosis is confirmed. Anyone with new temple pain, jaw pain on chewing or visual symptoms should therefore be assessed urgently rather than treated as migraine.

The NHS migraine page says to ask for an urgent GP appointment or NHS 111 if an attack has lasted longer than 72 hours or aura symptoms last longer than 1 hour at a time. It says to call 999 if you have a headache that came on suddenly and is extremely painful, problems speaking or remembering things, vision loss, blurred or double vision, drowsiness or confusion, a seizure, a very high temperature with symptoms of meningitis, weakness in the arms or legs on one side of the body or face, or a recent head injury. It says not to drive yourself to A&E.

The Migraine Trust says it can be difficult to tell migraine from stroke, especially TIA, because aura symptoms such as visual disturbance, numbness or tingling, dizziness and speech difficulty can be similar, and hemiplegic migraine can be mistaken for stroke. Stroke can cause a headache like migraine, and a stroke can be mistaken for a migraine attack. A rare condition called migrainous infarction involves aura lasting longer than 60 minutes with a scan showing damage. It adds that migraine with brainstem aura, with features such as tingling in the hands and feet, dizziness, speech problems and visual disturbances in both eyes, can also be mistaken for stroke or TIA.

The sensible rule for older people and families is that new weakness, facial droop or speech difficulty is treated as stroke first, with a 999 call, and not assumed to be an unusual migraine.

The NHS says migraine cannot be cured but treatment can help. For attacks it lists painkillers such as ibuprofen and paracetamol taken as soon as the headache starts, triptans and gepants, and anti-sickness medicines. To prevent attacks it lists beta blockers, antidepressants and epilepsy medicines, acupuncture, relaxation and cognitive behavioural therapy, and vitamin B2, plus lifestyle changes such as regular meals and less caffeine. It warns to try not to take painkillers for more than 2 days a week because this can cause more headaches.

For older adults, other medicines and conditions matter. The Migraine Trust says triptans tighten blood vessels, so they are unsuitable for some people; a doctor considers smoking, diabetes, high blood pressure, raised cholesterol, obesity, a history of bleeds or clots and family history, and may review regularly if you continue after 65. Other migraine treatments in later life are the same as for younger people unless pre-existing conditions or other medicines prevent them. Painkillers such as ibuprofen can raise concerns for older people with kidney, stomach or heart problems or on blood thinners, so ask a pharmacist before using them regularly.

The NHS suggests sleeping or lying in a darkened room during an attack, avoiding known triggers, staying hydrated, limiting caffeine and alcohol, keeping to a healthy weight, regular meals, regular exercise, sleep and stress management, and keeping a migraine diary to identify triggers. The Migraine Trust adds that many people with migraine also have other headache types such as tension-type headache, and that identifying them helps treatment.