Q&A: Living with migraine later in life
By: Ria Bhola, Headache Nurse Specialist, and Steph Weatherley, Senior Information and Support Services Advisor
Some people experience changes to their migraine in later life, which can be disconcerting. Here, we answer questions about migraine in later life that we hear on The Migraine Trust helpline.
Why am I experiencing migraine in later life?
Often migraine attacks occur in later life in people who are predisposed to migraine and probably have had migraine already at some point during their life. For example, some people might experience migraine attacks during childhood or early adulthood and then have no obvious migraine symptoms for many years, before experiencing migraine attacks again in later life. It is possible that certain lifestyle changes or other changes like increased stress or hormonal changes start to trigger migraine attacks again or make them worse in later life.
On the other hand, some people do find that their migraine improves or goes away in later life, it can vary from person to person.
If your migraine has become worse or more frequent and it’s unclear why, you should speak to your doctor.
Some people do develop migraine for the first time later in life. This can sometimes be a sign of an underlying health condition, so if you experience migraine for the first time or are worried about your health, talk to your doctor. They will be able to do a health check to rule out any other conditions and recommend treatments to help with your migraine.
Can I use triptans if I am over 65?
Triptans are not licensed for use in those over the age of 65 but their benefits can often be greater than the risks, providing there are no pre-existing vascular conditions or medications being taken that could interact with them. Vascular conditions refer to problems with the heart and blood vessels including high blood pressure. Triptans tighten blood vessels which will make them unsuitable for some people.
You can discuss triptan medications with your doctor and they can carry out an assessment to consider the risks and benefits of using triptans if you are aged over 65. Your doctor will consider risk factors such as smoking, diabetes, high blood pressure, raised cholesterol, obesity, a history of bleeds or clots and your family history. Once they have made these considerations and reviewed any risks they may be happy for you to continue using triptan treatments.
If you are over 65 and remain on a triptan medication, you may need more regular reviews with your doctor to assess any developing risks over time to ensure that these are still safe for you to use.
Other treatments for migraine later in life are the same as treatments for younger people, provided there are no reasons why you can’t take a certain medication such as pre-existing health conditions or other medications that you take. Your doctor will decide what treatment is best for you based on your symptoms and medical history.
Migraine and menopause, what happens?
Around times of hormonal change, such as menstruation, perimenopause or menopause, migraine attacks can change pattern and either improve or increase. During perimenopause they can take a few years to settle whilst hormone levels fluctuate. If your migraine is getting worse during the perimenopause or menopause there are other treatment options which your doctor can consider. It can be helpful to have your hormone levels checked with a blood test. This can help you and your doctor decide if additional treatment with hormones should be considered. Alternatively, you may be referred to a menopause clinic where your options can be discussed further and your doctor can make a plan to keep things more stable.
Once a woman’s periods have stopped, the hormonal cycle can continue for years afterwards. This can mean some women continue to get migraine attacks on a monthly basis, even when their periods have stopped. For most women, their migraine attacks settle down two to five years after the menopause.
After the menopause, women may find that migraine triggers that are not related to their hormones become more obvious, or that they develop new migraine triggers, for example neck tension.
The menopause can be a difficult time for women with migraine. The irregularity of periods can make it harder to cope, as migraine attacks may be more difficult to predict. Also, symptoms of the menopause such as hot flushes and night sweats can mean your sleep is disturbed and you may feel stressed. This can mean you are more likely to have a migraine attack. Some women do go back to using a preventive treatment for some time to help settle things.
Although some women continue to have migraine attacks after their menopause, for most women, when their menopause finishes, they find their migraine is a lot better.
If you or a loved one has questions about migraine or is in need of support, you can contact us via our free helpline on 0808 802 0066 or online here. You can also chat to us online through our new live chat service at migrainetrust.org.