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Migraine when you’re 60+ >> A few important observations

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A useful review was published last year in the medical journal Current Pain and Headache Reports, regarding migraine in patients over the age of 60. It was brought to my attention by an article in Everyday Health last month.

Senior with migraine and headache

It might be useful to get a quick overview of some of the report’s findings.

Many people with migraine are told that their symptoms will likely diminish or go away as they get older. And that is often the case, especially from a strictly statistical standpoint.

But you are not a statistic, you’re an individual. And the fact is that many people continue to have regular attacks into their 80s, or even start having attacks in their older years. The report found that 10% of older adults had migraine, now spread out more evenly between men and women.

If you started having attacks before the age of 18, you’re more likely to continue having attacks in later years.

How is 60+ Migraine different?

Attacks may not be different, but they can change throughout life. For example, many older adults find that:

  • Their headache pain is now more often two-sided
  • They may be less sensitive to light and noise
  • They may experience fewer “cranial autonomic symptoms”, such as congestion or watery eyes during an attack
  • Sometimes the attacks are less severe
  • They may experience “stroke-like” symptoms for the first time, including visual aura, trouble speaking, or difficulty with movement

How is 60+ Migraine diagnosis different?

Your headache specialist will want to make sure that you’re not suffering from other problems that become more serious with age. For example, since migraine attacks can mimic stroke, the most urgent thing with any new symptoms is to quickly rule out stroke.

Cardiovascular issues in general are important to check as well.

The report gives some helpful information about the timing of the headache. For example, if you have headaches that get worse at night, brain imaging might help with diagnosis. Headaches worse in the morning may indicate sleep problems, such as obstructive sleep apnoea.

It’s also all the more important for your doctor to know your medical history, and to watch for any current infections or other problems that may be related. It’s also very important that they pay attention to medications and supplements you may be taking, which could affect or even cause headaches.

How is 60+ Migraine treatment different?

Aside from ruling out other conditions, migraine treatment in older adults can be tricky because of concerns about medication interactions, and other contraindications (e.g. medical reasons why a medication may make another condition or risk factor worse).

CGRP related medications, although they don’t have the long-term history of other medications, are looking like a positive treatment for older adults. The study specifically mentioned lasmiditan, ubrogepant, and rimegepant. Candesartan, also used for high blood pressure, may help.

However, many older medications used for migraine may be used. Some, with newer evidence, are not as much of a concern as they used to be. So there are many other options that your doctor may suggest. The report simply gives the good advice that it’s especially helpful if you’re 60+ to start at a low dose and go up gradually. It requires patients, but it’s worth it.

Although the report briefly talks about lifestyle (diet and exercise), it doesn’t spend time talking about many non-drug treatments. These should be discussed with your doctor, but it widens the options significantly with good evidence-based treatments.

If you or someone you love is 60+ with migraine, it’s worth taking a look at this article, and the report – which is more technical, but has a lot of information.

What’s Up? – I’m Just Not Sleeping Well!

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Most of us know that poor sleep can trigger migraine attacks, or make migraine symptoms worse or more frequent.

What we may not realize, however, is that there are many, many reasons why we may not be sleeping well.

A teddy bear with insomnia. :(

So today we’re going to look briefly at a few of those reasons – and think about some basic information that we can give to a doctor or specialist to start looking for causes and treatments.

A few [surprisingly common] reasons why people don’t sleep well:

  • Depression: A case where one can make the other worse, and vice versa.
  • Sleep apnea (sleep apnoea): …of various types.
  • Hot flashes
  • Your pet: It’s moving around, getting up onto your bed… ? It’s a common problem!
  • Migraine: Of course, had to mention that one. Another case where one can make the other worse.
  • Caffeine
  • Some antidepressants: And other common medications too!
  • Worrying about not sleeping: Yup
  • Sleeping pills: Yes, not using sleeping pills properly can lead to major problems.
  • Overactive thyroid
  • Acid reflux
  • Restless Legs Syndrome
  • An uncomfortable bed: Just how old is that pillow?
  • Poor bedtime routine: For example, too much screen time in the last two hours of the day.
  • Temperature: In the room/bed
  • Alcohol: (in spite of common myths)
  • Heart failure
  • Obstructive Lung Disease
  • Someone else in the room who can’t sleep

…and those are only a few examples. As you can see, some are serious in themselves, some not. Some are obvious, some are not. Some are easy to fix, some are not. But it helps to open up your mind and think about all the possibilities, instead of just assuming it’s one or two of the more commonly mentioned things.

It’s critical that we think about sleep when we’re trying to get good treatment for migraine, and other headache conditions as well. So where do we start?

Easy Sleep Evaluation

It helps to evaluate your own sleep, and then bring the information to your doctor. This doesn’t mean using an app with complicated charts, although that might be useful. And actually, you want to avoid obsessing too much about your sleep on a daily basis, which can easily make things worse.

Harvard Medical School has published a very useful “sleep diary” to fill out. There are simple questions for before bed, and after you wake up. They recommend using this diary every day for a week before talking to your doctor or specialist.

Before bed:

  • Medications during the day
  • Caffeinated beverages during the day
  • Alcohol during the day; list amount and time
  • Exercise during the day
  • Sleepiness during the day
  • Naps during the day
  • Food consumed within three hours of bedtime
  • Activities within two hours of bedtime

In the morning:

  • Bedtime last night
  • Approximate time it took to fall asleep
  • Approximate number of awakenings during the night
  • Reasons for awakening, if known
  • Time of awakening for the day
  • Level of energy and alertness after waking up in the morning (feeling refreshed?)

If you sleep with someone else in the room, also ask them what they’ve noticed about your sleep.

For more useful information, check out the full article here: Insomnia: Restoring restful sleep

CPAP and Headache: for Better or for Worse?

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Most people know CPAP (Continuous Positive Airway Pressure) as a treatment for sleep apnea. Essentially, a machine connect to a mask, which pumps air under pressure to the lungs, keeping the windpipe open while you’re asleep. The windpipe remains “unobstructed”, thus helping with obstructive sleep apnea.

CPAP and Headaches
Illustration courtesy PruebasBMA
But over the past few years, patients and researchers have become interested in another aspect of CPAP machines. That is, their relation to headaches.

There are three aspects to this question:

  1. Could CPAP machines actually cause headaches, or at least make them worse?
  2. Is sleep apnea related to headaches and migraine? In other words, could treating sleep apnea also fight headaches?
  3. Could CPAP machines be a treatment for headaches, migraine, and even cluster headache?

Let’s start with #1. Yes, some people have noticed an increase in headache symptoms when they use the CPAP machine. This shouldn’t be surprising – any significant change can certainly trigger an attack in people with migraine disease.

However, there may be some good solutions (besides avoiding CPAP treatment). One would be “giving it time”, of course, but one business focused on sleep related medical equipment reports that there could be a simple solution:

Sinus systems extend behind your ears. When a CPAP is used and part of the sinus cavities are blocked, a situation is created where there is a pressure differential between the sinus cavities affected. These pressure differences can sometimes be felt as sinus headaches or just plain headaches, even though they are caused by sinus blockages. These can be treated using over the counter medications to open the sinus. CPAP heated humidifiers can also open and maintain sinus systems. If you do not use a heated humidifier, we strongly suggest using one. If this does not correct the problem, visit your ENT. [Why do I have a headache when I wake up?]

These are common recommendations from both companies with experience and doctors. Check if a pressure adjustment is needed, and consider a CPAP heated humidified (and make sure it’s working properly).

Also, you may have a reaction to the straps used for the mask. See if you can loosen them or try a different type of mask/strap.

While a temporary increase in headache symptoms may be common, it’s also common that headache symptoms decrease – or disappear – when a patient starts using a CPAP.

A few people from our community have shared their stories of unexpected success – see Sleep Apnea and Migraine – Comments from You!

It seems that sleep apnea (sleep apnoea) is a significant trigger for headache attacks, such as those from migraine. In 2013, for example, a study was released that showed significant improvement in migraine patients with sleep apnea who started using CPAP (CPAP Improves Migraine Burden in Patients With Sleep Apnea). Another study also found that patients with obstructive sleep apnea and migraine often improved significantly if they were committed to CPAP treatment.

Could CPAP work specifically as a treatment, even if patients aren’t diagnosed with sleep apnea? And which patients are most likely to benefit?

Much more study is needed, and some studies are beginning. For example, a CPAP study in Norway will be evaluating the use of CPAP for cluster headache treatment.

In the mean time, it’s very important for doctors to pay attention to the sleep patterns of headache patients. There are probably a high number of patients with headache symptoms who have undiagnosed obstructive sleep apnea. In fact, doctors could make a lot of headway just by asking a simple question – When you woke up this morning, did you feel refreshed?

For more on sleep apnea and migraine in particular, listen to this podcast.

Sleepwalking, Headache, and Pain

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Just how common is sleepwalking? Estimates range quite a bit, although a study in 2012 suggested that almost 30% of us walk in our sleep sometime in our lives.

Those who sleepwalk on a regular basis do tend to complain that they’re sleepy during the day. But there may be a lot more to the condition than we realize. Sleepwalking is closely related to other disorders, including depression, headache, and migraine.

Sleepwalking, Headache and Migraine
Photo courtesy Herzi Pinki

The relationship between sleepwalking and migraine is a complex one. For example, depression and migraine are also linked. Magnesium levels are linked to both migraine and sleepwalking. Changing sleep schedules are linked to both. Certain medications may affect both, such as antihistamines, mild tranquilizers and a few antipsychotics. Obstructive sleep apnea is also strongly related to both.

This spring a report on a fascinating sleepwalk study was released. The authors of the study confirmed that migraine and headache were highly associated with sleepwalking. (This doesn’t mean that most migraine patients walk in their sleep. It does mean that if you sleepwalk you are much more likely to have migraine.)

But a fascinating twist is that patients were very unlikely to experience pain while sleepwalking. In other words, banging your knee on the table while you’re sleepwalking is unlikely to even wake you up. In fact, one patient fell off his roof and broke his leg, but didn’t wake up until the morning!

There are obviously many mysteries about pain still to be solved. However, there are some key things you can do about sleepwalking, especially if you have migraine as well:

Focusing on your sleep may actually help relieve migraine and stop sleepwalking. It’s funny in fiction, but it needs to be taken seriously in real life.

For more on the recent study into sleepwalking and pain, read Sleepwalkers feel no pain, remain asleep despite suffering injuries from ScienceDaily. Also check out this Sleepwalking Overview from emedicinehealth.

Headache Waking You Up? Could Be Hypnic Headache.

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You’ve noticed it’s starting to happen on a regular basis. All of a sudden, you wake up with a headache.

You didn’t have the headache when you went to sleep. Where did it come from? It may just be mild, but it could be severe – you might even feel sick.

Hypnic Headache - waking you up?Now that you’re awake, the headache lasts for a few minutes – but could even last up to four hours.

And it’s happening several times a week now – twice a week, maybe four times, or even every night.

It’s possible that you have a rare kind of primary headache known as hypnic headache.

But don’t jump to conclusions too quickly. This headache, sometimes known as the “alarm clock headache”, really is quite rare. It tends to happen in people over the age of 50, and it can easily be misdiagnosed.

The reason is that there are many other reasons why you may wake up with a headache. Sleep apnea is a common trigger of certain headaches, for example.

If you wake up feeling restless, it probably isn’t hypnic headache. A hypnic headache generally won’t last for more than 4 hours. And it will wake you up quite often – more than twice a week, often every day.

If you suspect you have hypnic headache, your doctor will want to ask some questions to try to find an underlying cause. Chances are she will give you a different diagnosis. Like I said, it’s rare.

However, if you are diagnosed with hypnic headache, there are some excellent treatments.

A recent study suggested that lithium is the best treatment for these types of headaches. Oddly enough, caffeine consumption upon waking is the second-best treatment. Melatonin or indomethacin may also be tried if these are not effective.

For more information about hypnic headache, check the links below:

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The articles on Headache and Migraine News are © 2004-2024 J. Cottrill.
Every effort is made to ensure the accuracy of each article, and to point you to further sources of information. However, this site is for informational purposes only and should never replace a visit to your doctor.