Migraine in the Elderly Compared With Migraine 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.
Similar to what happened in other Countries, after the decade of 1960 there has been an exponential increase in the age of the Brazilian population. From 1940 to 1945, the mean age of Brazilians was only 39 years. In 1992, 13 million of Brazilians were older than 65 years, and the mean expectancy of life was 67.3 years. It is estimated that, until the year 2020, the mean expectancy of life in Brazil will reach 72 years.
The increase in the median age of the population translates into important public health challenges. It is natural, therefore, that diseases of the elderly associated with significant mortality (cancer, cardiovascular disturbances) and morbidity (dementias, arthritis) get more attention and consequently more resources. This fact at least partially explains why migraine, despite its enormous prevalence in the population, is poorly studied in the elderly. Nonetheless primary headaches are prevalent in this phase of life. Waters, in an epidemiologic study, found that, in those older than 75 years, 21% of the men and 55% of the women had recurrent headaches, figures lower than those reported by Newland et al for the same age range (45% of the men and 62.7% of the women).
Headaches are not just prevalent, but they also cause a significant burden on the quality of life of the elderly. Results of the project Dunedin, conducted in Florida in 1985 to assess the impact of several health-problems in a cohort of subjects older than 65, found that headache was the 10th most disabling problem in women and the 14th in men at this age range. A total of 11% of the women and 5% of the men had recurrent and severe headaches.
Most studies assessing headaches in the elderly focused on the secondary headaches. Few studies investigated primary headaches at this age range. There is a real lack of studies assessing and refining the diagnosis of migraine in the elderly, and we could not find indexed studies comparing the clinical features of migraine in the youngster and the elderly. Studies on this issue are, therefore, appropriate. Consistently, herein we aimed to contrast the migraine symptoms experienced by subjects older than 60 years with migraine happening in those aged 20 to 40 years.
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.
Similar to what happened in other Countries, after the decade of 1960 there has been an exponential increase in the age of the Brazilian population. From 1940 to 1945, the mean age of Brazilians was only 39 years. In 1992, 13 million of Brazilians were older than 65 years, and the mean expectancy of life was 67.3 years. It is estimated that, until the year 2020, the mean expectancy of life in Brazil will reach 72 years.
The increase in the median age of the population translates into important public health challenges. It is natural, therefore, that diseases of the elderly associated with significant mortality (cancer, cardiovascular disturbances) and morbidity (dementias, arthritis) get more attention and consequently more resources. This fact at least partially explains why migraine, despite its enormous prevalence in the population, is poorly studied in the elderly. Nonetheless primary headaches are prevalent in this phase of life. Waters, in an epidemiologic study, found that, in those older than 75 years, 21% of the men and 55% of the women had recurrent headaches, figures lower than those reported by Newland et al for the same age range (45% of the men and 62.7% of the women).
Headaches are not just prevalent, but they also cause a significant burden on the quality of life of the elderly. Results of the project Dunedin, conducted in Florida in 1985 to assess the impact of several health-problems in a cohort of subjects older than 65, found that headache was the 10th most disabling problem in women and the 14th in men at this age range. A total of 11% of the women and 5% of the men had recurrent and severe headaches.
Most studies assessing headaches in the elderly focused on the secondary headaches. Few studies investigated primary headaches at this age range. There is a real lack of studies assessing and refining the diagnosis of migraine in the elderly, and we could not find indexed studies comparing the clinical features of migraine in the youngster and the elderly. Studies on this issue are, therefore, appropriate. Consistently, herein we aimed to contrast the migraine symptoms experienced by subjects older than 60 years with migraine happening in those aged 20 to 40 years.