Acute migraine treatments in patients above age 65

Migraine remains a prevalent and disabling condition in older adults, yet there are limited data guiding acute treatment in patients over the age of 65 years. This population is often underrepresented in clinical trials and there are special considerations to take with management in this population including age-related pharmacokinetic changes, comorbidities, and increased risk of medication-related adverse effects.

In this narrative review, we aim to highlight the current acute treatments for migraine and considerations that should be taken when choosing medications in older adults, including assessing vascular risk factors, polypharmacy, declining kidney function, delayed gastric emptying, and impaired liver metabolism.

This is a narrative review on the current literature and evidence for the use of acute medications in patients with migraine who are 65 years old or older. The authors queried both PubMed and Google Scholar for relevant publications in February-March 2025.

The authors provide a breakdown of acute medication treatment options and include special considerations by class. The classes discussed include non-steroidal anti-inflammatory drugs, acetaminophen, triptans, ergotamines, gepants, ditans, neuromodulation, and nerve blocks.

Ultimately, effective and safe acute migraine management in patients over age 65 years requires applying the best available evidence, understanding knowledge gaps, and engaging in shared decision making. Better data and guidelines are needed to enable clinicians to make informed treatment decisions and to safely provide reassurance to patients who benefit from these therapies.