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Migraine is a common neurological condition, affecting more than a billion people every year. It has a high morbidity rate and is most common in young adults and women. Traditionally associated with the younger demographic, migraines have emerged as a significant health concern among the elderly. Recent studies reveal a notable uptick in the prevalence of migraines in the elderly, shedding light on the underrecognised and often overlooked nature of this issue. Ageing brings about a myriad of physiological changes in the brain, and some of these alterations can exacerbate the frequency and severity of migraines. As individuals age, there is a natural decline in cerebral blood flow. In migraine-prone people, such changes in blood flow may trigger more frequent and severe attacks. Additionally, the ageing brain often exhibits reduced resilience to stress. Stress is a known trigger for migraines, and this can contribute to the worsening of migraine episodes.
Medication & treatment challenges
The assumption that headaches are a natural part of ageing may often lead to downplaying of the condition. The nature of migraines in the elderly poses unique diagnostic challenges. Symptoms may manifest differently, with aura (warning signs) becoming less frequent along with an increase in persistent headaches. This altered clinical presentation often leads to misdiagnosis or, more commonly, an oversight of migraine as a potential cause. Moreover, migraines frequently coexist with other chronic conditions, complicating the diagnostic landscape. Conditions such as hypertension, arthritis, or neurodegenerative disorders may mask or exacerbate migraine symptoms, contributing to the underreporting and inadequate management of this condition.
Moreover, the growing polypharmacy trend, where elderly patients receive multiple medications for various conditions, creates another hurdle. The risk of Medication Overuse Headache (MOH) increases, making it challenging to differentiate between headaches caused by medication side effects and primary migraines. Additionally, clinicians have to be mindful of the potential drug interactions and adverse effects in patients with multiple comorbidities. This poses a barrier to identifying suitable treatment options.
A solution-oriented approach
The rising prevalence of migraines in the elderly necessitates a shift in healthcare practices. Here are some key strategies for improved management:
Enhanced vigilance in diagnosis: Healthcare providers need to actively screen for migraines during geriatric assessments. A comprehensive evaluation encompassing a detailed medical history and a focus on headache characteristics is crucial for accurate diagnosis.
Prioritising non-pharmacological options: Due to potential drug interactions and age-related sensitivities, non-pharmacological interventions often hold greater appeal for managing migraines in the elderly. Techniques like stress management programmes, cognitive behavioural therapy, relaxation techniques, and regular exercise have all proven effective in reducing migraine frequency and severity.
Harnessing technological advancements: Non-invasive neurostimulation devices like Remote Electrical Neuromodulation (REN) and Transcranial Magnetic Stimulation (TMS) offer promising tools for migraine management in this population. REN utilises gentle electrical pulses to stimulate nerves and modulate pain signals, while TMS employs magnetic fields to target specific brain regions, aiming to reduce both the frequency and intensity of migraine attacks. One of the key benefits of REN is its safety profile and higher tolerability compared to traditional pharmacological therapies. As the elderly often have multiple comorbidities and are prescribed
multiple medications, the risk of adverse drug interactions and side effects is a significant concern.
REN, being a non-invasive and drug-free approach, eliminates these risks, making it a safer and more well-tolerated option for the older population. These devices are designed to be compact, discreet, and easy to use, empowering patients to take control of their migraine management. The portability of these devices allows older adults to administer treatment on-the-go, without needing to visit a healthcare facility repeatedly. This improved accessibility and convenience can encourage greater treatment adherence and improve long-term outcomes.
As migraines complicate the healthcare needs of the elderly, integrating advanced diagnostic tools and non-invasive approaches such as neuromodulation can help personalise management. These innovations offer hope for more effective strategies, marking a significant leap forward in improving their quality of life.
(The author is a Bengaluru-based senior consultant in neurology.)