Managing migraine and other headache syndromes in those over 50.

Migraine in an older person may appear with sensory or motor phenomena ("late-life migraine accompaniments"), so that it may be confused with transient ischemic attack or stroke. An older patient may have cervicogenic headache in addition to migraine. Medication overuse headache is just as much of a problem in older patients as it is in younger ones. Abdominal migraine without headache can be seen in older adults as a migraine equivalent, just as it can occur in children. The most effective drugs for migraine prophylaxis in young people (divalproex, topiramate, metoprolol and propranolol) are similarly effective for those who are over the age of 50. Oral rescue drugs, including naproxen and hydroxyzine, are also useful in older adults. We need to remind older adults about the dangers of excessive use of caffeine in coffee, tea and energy drinks, since these substances can lead to daily HA and migraine equivalents.