Migraine in the elderly: A comparison with migraine in young adults

Objective-In this study we compare the clinical features of migraine attacks occurring in the elderly (60 to 70 years) and in younger migraineurs (20 to 40 years). Background-Studies comparing the clinical features of migraine at different ages are still lacking. These studies are important for a better comprehension of the natural history of migraine, as well as to refine our recognition of the disease. Methods-We retrospectively assessed subjects seen from 1995 to 2000 in a university-based outpatient headache clinic in Brazil. We reviewed 144 charts from patients 60 to 70 years (mean = 66.4). We applied a questionnaire based on the first edition of the International Classification of Headache Disorders (criteria for episodic migraine remained unchanged in the second edition). Controls were migraineurs from 20 to 40 years (mean = 32.6). Results-Migraine occurred in 25% of the elderly and 29% of younger migraineurs (NS). A lower proportion of migraine attacks in the elderly were unilateral (38% vs. 57%, P < .01), or with associated symptoms (nausea = 75% vs. 86%, P= .05; vomiting = 30% vs. 54%, P < .05, photophobia and phonophobia = 83% vs. 94%, P < .05). Other symptoms such as paleness (P= .0441), dry mouth (P= .0093), and anorexia (P= .05) were more common in the elderly. Conclusion-Migraine is less typical in the elderly and more frequently associated with vegetative symptoms. Therefore, the diagnosis of migraine in elderly subjects may be more challenging, and many seniors with this primary headache can be misdiagnosed.