Headache medication overuse common among older migraineurs

Older migraineurs have a high prevalence of headache medication overuse, according to a retrospective review of records from more than 200 older migraine patients published in Headache. In addition, about 80% of patients reported severe headache pain.

Studies involving the characteristics of migraine in older patients are rare, but some studies have described a change in headache intensity, location, and type as patients age.

Using the French National Observatory of Migraine and Headaches, the researchers sought to capture headache characteristics of older patients with migraine by reviewing data from patients older than 64 years of age at their first visit. For the analysis, medication overuse was defined as usage of > 15 days per month for a simple analgesic and > 10 days per month for an ergotamine, a triptan, an opioid, or a combination analgesic for ≥ 3 months.

In this study, 239 patients (189 women, 50 men) were included—175 had migraine without aura, 33 had migraine with aura, and 31 were diagnosed with both. Mean age at entry was 69.5 years.

Almost 60% had a unilateral pain location, and 50.2% had throbbing headache. The headache was reported to be severe in 79.9% of patients. In 40.2% of patients, headache duration was between 24 and 72 hours, while one in five (20.5%) had a duration < 12 hours. One in four (27.2%) had a duration between 12 and 24 hours.

The most common accompanying symptoms were photophobia (77.4%) and phonophobia (79.5%). Nausea was present in 70.3% of patients, and vomiting in 38.9%. Nocturnal migraine attacks occurred in 30.1% of patients.

Seventy-nine patients (33%) met the criteria for medication overuse headache. In this group, every patient went through medication withdrawal, the authors noted. More than one-third (35.4%) went from chronic daily headache to episodic migraine after medication withdrawal, while 11.4% had no change in headache frequency and 53.2% were lost to follow-up. Nearly three-fourths of this group (70.9%) overused more than one drug.

Approximately 10.5% had triptan overuse, and 23.4% had combination analgesic overuse. A history of anxiety was present in 20% of the group with medication overuse headache compared with 8.9% of those without medication overuse headache. Depression was also more common in the former group (32.5% vs 17.2%).

Other headache characteristics in the overall study population included:

• Approximately 45% of patients had low-frequency migraine, and 17.2% had high-frequency migraine.
• In those with aura, 50% reported episodes of aura without a headache.
• Pulsatility was found in 60.2% of patients with migraine onset before age 18, 42.9% in the group 18 to 64 years old, and 20% in those > 64 years of age.
• Patients whose headaches that started before age 18 presented with a higher frequency of migraines than those whose headache onset was between the ages of 18 and 64 (23.9% vs 11.7%). No patient > 64 years presented with high-frequency migraine.

The authors acknowledged the study had limitations. It was based on records from a tertiary headache center, so the findings may not extend to the general population of migraineurs, the authors noted. In addition, the patients who were reported to have potential medication overuse headaches were typically diagnosed during consultation based on a headache diary. However, diaries are difficult to survey, and biases could be present. 

“We have confirmed many characteristics of migraine in the elderly, but in a larger base sample of migraineurs,” the authors concluded. “Furthermore, we submit the idea that migraine characteristics in the elderly could be linked to age of onset.”

To read more about this study, click here.