The Mindful Migraine

Oops! Today’s notes come from the 2024 Migraine World Summit held last year, and summarizes my understanding of the interview with Dr Messoud Ashina, Professor of Neurology, University of Copenhagen.

Dr Ashina started by noting that the typical trajectory for migraine is that it starts in early adulthood, peaks in mid-life, then becomes less severe in later years.  He noted that it is important to understand as much as you can about your migraines and their patterns because migraine tends to get harder to manage as you age, and having an effective treatment plan in place as soon as possible helps carry you through.

Apparently, the split between girls and boys with migraine is fairly even in the early years, but switches at puberty, to be much more weighted towards women, and gets exaggerated as people grow older.

Dr Ashina noted that migraine physiology is complicated and there is still a lot about it we don’t understand.  He noted, for example, that it was unclear why for some people their migraines follow one type of pattern as they age (and here he traced a bell-curve with his finger) and why for others it is more linear (he drew a straight line that increased evenly with age).  He noted that asthma and allergies are similar in the way that they change over your lifetime.

He noted we still don’t understand why migraines can stay episodic for some people, but for others they turn chronic.  Or, why for some people things get worse when they reach their later years.  But he did acknowledge that it was much harder to help patients after the age of 60.

One of the reasons that he gave, was that older patients are usually excluded from clinical research trials.  This age group, being older, tends to have other medical issues that might interfere with the test results.  So, they tend to be “discriminated against” and left out of test samples.  This makes it harder to know which medications will work best for them.  He acknowledged that as difficult as it might be, we really need more tests to include older people.

He suggested that for this age group chronic migraines were more likely to be less intense – even more stable in their patterns – but more persistent.  [That’s me!] He also implied that aura might increase in this age group, happening more frequently, and it might also happen without headache pain. 

If migraine or aura appears for the FIRST TIME in your late 50s or 60s, it is usually a red flag to test for other causes.

When asked why migraines might become chronic in later life, Dr Ashina noted it may be due to other issues such as weight gain, medication overuse over a long time, perhaps the effects of smoking or metabolic changes and syndromes (just as the likelihood of stroke, heart disease and diabetes increase with age).  Cognitive changes were also raised.  He did not suggest there was a direct link between migraines and dementia, only that our brains change as we age.

Menopause (which is reached when you have gone a whole 12 months without a period) often ends migraines for older women.  [For men, the comparative phase is andropause (when testosterone drops).]

One thing which was interesting was that he noted that depression and anxiety can be a negative consequence of migraine – but – they needed to be treated as a sperate issue, not assumed to just be a side-effect of migraine.  [I just wrote about this – here.] He recognized that the sicker you get, the sadder you might get, but also noted that exercise might lift your spirits but not your migraine. Similarly, brain issues (poor memory, brain fog, etc) might also be an issue – but they are a separate issue.  Sometimes you improve your migraine health and the other issues go away, sometimes you need to address them separately.

The main message is – as you age your body changes – as your body changes your migraines might change – and as you and your migraines change your treatment plan should also change.

Moving forward – prioritize your overall health, try to stay fit, manage your lifestyle, keep your stress low and keep tabs on your ‘issues’.   A doctor won’t have enough time to ask you 101 questions at your next consultation, but if you have notes of things that might assist (like a migraine trigger tracker) – let them know.

And my favorite advice of all – stay curious.

Take care taking care friends, no matter how old or young you are, Linda x

PS – In one week’s time the Migraine World Summit for 2025 starts – you can read more or register for free here: 2025 Summit – Migraine World Summit

[PPS – don’t forget there is a migraine trigger tracker that I made and used over on my RESOURCES page – cheers.]

PPPS – disclaimer – remember that I am not a doctor, so please speak to a healthcare professional if you require medical advice.