Migraine changes with age: IMPACT on migraine classification.

OBJECTIVE: To establish if criteria for the diagnosis of migraine change with age and to document the influence of age on the full spectrum of migraine features. Also to define the clinical spectrum and provide a prognostic profile of migraine stratified by age.
BACKGROUND: Few studies have formally analyzed migraine characteristics stratified by age in a large cohort of patients.
METHODS: One thousand nine consecutive patients meeting ICHD-2, 1.1, 1.2, and 1.5.1 at their initial office visit were studied. Patients were stratified by age into 3 groups: group I, 16 to 29, group II, 30 to 49, and group III, 50 years or older. Variables studied included gender, headache duration in years, prodrome, aura, postdrome, headache triggers, headache characteristics, associated symptoms, headache location, headache frequency, headache days, and disability. Ordinal variables were graded from 0 to 3 but only grades greater than grade 1 (more than occasional) were used in the study.
RESULTS: A total of 86.3% patients were female and mean age was 37.7 years +/- 11.7 years (range 16 to 80), headache duration 15.0 years, and headache frequency 10 headaches per month. STUDY
RESULTS: No significant age differences were seen in gender, or frequency of prodrome, aura, or postdrome. In patients with aura the percentage of headaches with aura significantly decreased with age. Headache triggers, in general, showed no age differences; specific triggers showed statistical differences: stress as a trigger decreased with age; alcohol, smoke, and neck pain triggers increased with age, while in women hormones as a trigger peaked markedly in the 30- to 49-year-old age group compared with the other ages. Exercise, food, not eating, heat, lights, perfume, sex, sleep disturbance, sleeping late, and weather triggers showed no significant differences in age. Headache location showed no differences except for neck location, which significantly increased with age. Associated symptoms of photophobia, phonophobia, dizziness decreased with age and running of the nose/tearing of the eyes increased with age. Nausea, vomiting, osmophobia, taste abnormalities, and diarrhea showed no significant differences. Headache quality showed decreasing throbbing, pressure, and stabbing with age, but aching showed no statistical difference. Being forced to sleep or rest with headache showed a significant decrease with age, but no significant differences were seen in other acute migraine characteristics, including choose to sleep or rest with headache, function during headache, average intensity and duration of headache, recurrence rate of headache, headache aggravation by activity, response to acute medication, and acute medication satisfaction. The 50+ age group tended to have less dizziness, photophobia, phonophobia, nausea, vomiting, temporal location, throbbing, pressure, stabbing, headache days, moderate days, severe days, aggravation of headache by activity, and recurrence but tended to have more mild days, greater ability to function during headache, and greatest response to acute medication. Despite no difference from other groups in headache intensity and duration of headache, these findings taken together seem to reflect a "lesser migraine" in the 50+ age group.
CONCLUSIONS: This study highlights specific age differences in migraineurs, in most instances showing an age decline in frequency of variables, such as stress as a trigger, photophobia, phonophobia, dizziness, throbbing, pressure, stabbing, and being forced to sleep or rest with headache. Hormones as a trigger peaked in women in the 30- to 49-year-old age group. Increases with age were seen with alcohol, smoke, and neck pain triggers, neck location, and running of the nose/tearing of the eyes. The 50+ age group showed trends suggesting a "lesser acute migraine attack." These findings support the concept of lessening features of migraine over time resulting in a lower prevalence of migraine in older patients.