Is migraine in the elderly a distinct entity? A comparative cross-sectional study

The clinical characteristics, disability, and comorbidities of migraine are not well characterized in the elderly, especially in comparison with the young. We aimed to study the headache characteristics, treatment profile, disability, and pattern of comorbidities in the elderly patients with migraine and compare these with those of younger patients with migraine to see if migraine in the elderly differs significantly from that in the young.

We conducted a comparative cross-sectional hospital-based study of patients (n = 154) with migraine, aged 60 years and above (n = 81), and between the ages of 20 and 40 years (n = 73). In addition to the demographic and clinical details, patients were also evaluated with Migraine disability assessment questionnaire for disability and the Visual Analogue Scale for severity of headache. We also assessed anxiety, depression, and sleep quality.

Women constituted the majority of the elderly and young age groups. Migraine was less throbbing (p < 0.001), more likely to be holocranial (p = 0.009), more frequent (p = 0.043), less severe (p=<0.001), less likely to be associated with vomiting (p = 0.003), less disabling (p=<0.001) in the elderly as compared to the young. The prevalence of medication overuse headache (p = 0.014), depression (p = 0.004), and poor sleep quality (p = 0.001) was higher in the elderly with migraine group.

The migraine in the elderly, though more frequent than that in the young, is less severe and less disabling. The prevalence of medication overuse headache, depression, and poor sleep quality is significantly greater in the elderly. Hence, considering migraine as a distinct entity may yield a better understanding of the disease and improve treatment outcomes.