Migraine Evolution and Treatment According to Age

I can attest to the evolution of migraines over the years. Knowing when a headache is just a headache, a migraine, or something else is paramount. As a neurologist, this was even more important because someone’s life could be seriously devastated by the wrong diagnosis.

Migraines are hormone dependent

This is the reason why boys have more headaches than girls till puberty at which time roles reverse. As we women go through pregnancy, the rate decreases. This is not to say that some women cannot have migraines while pregnant. As expected my headaches which usually consisted about 1-3 a month became almost nonexistent during my pregnancy. As I entered my third trimester, I suddenly developed a whopping headache not unlike the hemicranial throbbing pulsating type I often get accompanied by nausea and scintillating lights. The headache became bilateral within a day. Having migraines all my life automatically assumed this was migraine- not being able to resort to my usual treatments due to potential harm to my baby, I resorted to taking Esgic (tylenol based for safety of baby). But this did not have the expected effect and headache persisted with worsening visual problems. Knowing that my headaches rarely lasted more than a day, plus vision seemed to be getting dimer I returned to doctor. Lo and behold, I had develop severe hypertension and eclampsia in 2 days’ time. So my headache was no longer a migraine but a vascular one and I required intervention.

Then after Parkinson’s diagnosis, I discovered that PD not only interferes with menstrual cycle but menses makes PD symptoms worse. Subsequently, the irregularity triggered nearly daily migraines despite appropriate treatment which included Botox. Voila! My migraines reverted to its previous frequency after my hysterectomy.

Color change of migraines

In my practice as well as dealing with my own and family’s migraines, I have learned that these changes in character, flavor, and intensity become much more sensory akin to those of children, where the actual headache is not a big component. Rather people like me get more motion sickness, nausea, light and noise sensitivity, but most pronounced are the dizzy spells that occur with headache. The actual headache can precede the dizziness but more often in my experience follows it within a day. Although, this is a typical presentation for someone that has had migraines their entire life we cannot take lightly these symptoms which could mimic a stroke. The one thing to distinguish a migraine from a mini- stroke (transient ischemic attac -TIA), is gradual buildup of symptoms rather than sudden. Also duration helps to distinguish between the two. The TIA’S usually last less than 15 minutes while migraines can last hours to days.

Another vestibular migraine presentation which I have experienced recently is a sudden ear pressure, ringing and positional ear pain triggered by head movement. These have very specific triggers like red wine; so managing triggers is important as well as using prophylactics if frequent.

Similarly, older people can have basilar migraines. (Stroke and subdural hematomas need to be ruled). The presentation is similar to vestibular migraines except these have double vision, slurred speech, incoordination followed by a headache within 45 minutes.


Treatment depends on age, hormonal status, frequency, duration as well as other underlying medical problems such as heart disease and or high blood pressure.

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