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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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • Ronan
    2 years ago

    Question: How do women who are pre-menopausal or in full menopause handle migraine now then in their earlier years. The frequency of migraines have lessened due that I am on an anti-depressent and I no longer work or go to school (started back at 41). I had a migraine every day due to hormonal changes and the stress of school. When I do get a migraine it is much much worse. It lasts 3 days and it effects my whole body. I’d like to put a part-time job in my life but I am afraid the migraines will get more frequent with the same severity they are now.

  • maria.deleon moderator author
    2 years ago

    Sorry life is impacted so severely. Sometimes we use amerge or frova which are long acing Triptans to prevent catemenial ( menstrual) headaches. Take longer to kick in about an hour but lasts up to 24 hours. I like to use amerge over frova but this is personal preference. Recommendations are 1 amerge a day 2 days prior to meses and first 3 days of cycle to prevent.

  • maria.deleon moderator author
    2 years ago

    Sorry life isn’t impacted so severely. There are several ways of treating long migraines and especially those related to menstrual cycle. 2 good medicines that we use for cathemenial migraines ( menstrual) is taking either amerge or frova ( I personally preferred amerge) 2 days before cycle and 3 days into cycle ( so 1 tablet each month for 5 days) this usually prevents headache ..also if headaches tend to last long time these two are longer acting but do not work as fats take at least an hour to kick in .talk to your doctor for options..also sometimes we use sssris as preventive and even use only during cycle to decrease frequency and severity of migraines during this time…best of luck

  • pigeongirl
    2 years ago

    oh boy yes- “Rather people like me get more motion sickness, nausea, light and noise sensitivity, but most pronounced are the dizzy spells that occur with headache. ” and vertigo for me too. and the ears… i have FHM with ‘brainstem’ attacks as well. crazy stroke like symptoms since childhood- and now one of my children as well, may wake looking like a drunk, unable to speak or walk. other possibilities have been ruled out, thanks to great doctors, and we often have a great quality of life between attacks. that said i still live 2/3 of my days with nausea, vertigo of varying degrees, light sensitivity, scent sensitivity, dizzy spells that are helped by of all things potato chips, weak spells i cannot push through, bouts of fainting and falling asleep at random, a weak/numb or paralyzed left side, all the symptoms besides the headache. we pay attention to the weather like a hawk, and the monthly cycle- allowing some ability to at least be prepared for attacks in our case- now that food and other controllable triggers are managed well 🙂

  • Ronan
    2 years ago

    Not quite the monthly cycle. I can handle that. It’s the craziness with premenopause.

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