Narrative review of migraine in older adults and aging-related complexity
This narrative review describes migraine after age 60 as often atypical and underrecognized, with substantial burden and treatment challenges shaped by comorbidity, frailty and polypharmacy. [1]
Automatic summary · not editorially reviewed
The key findings
The narrative review, following SANRA principles, covers epidemiology, clinical presentation, pathophysiology and management of migraine in older adults. [1]
Migraine in older adults often presents atypically, for example as aura without headache or vestibular symptoms, which can delay or misdirect diagnosis. [1]
The review reports that contraindications, susceptibility to adverse drug effects and polypharmacy complicate treatment and support individualized, non-pharmacological approaches. [1]
The source at a glance
- Study type / format
- Narrative review (abstract only)
- Population / context
- Older adults, particularly people aged over 60, with migraine
- Summary based on
- Study abstract
- Original publication
- April 17, 2026
Migraine after 60 in a narrative review
The source is a narrative review written according to the SANRA principles. It aims to give an overview of the epidemiology, clinical presentation, pathophysiology and management of migraine in older adults, focusing on age-related complexities, therapeutic challenges and unmet clinical needs. The authors note that migraine is traditionally seen as a disorder of younger people, yet it often persists or first appears after age 60 with atypical features, which adds diagnostic uncertainty.
Supporting source [1]
Atypical features and broad burden described
According to the review, migraine in this population often shows atypical or misleading features, such as aura without headache, vestibular symptoms, or overlap with cerebrovascular conditions, leading to delayed or incorrect diagnoses. The described burden affects physical function, mobility, cognition, emotional well-being and social participation, and is amplified by comorbid cardiovascular and metabolic disorders, mood disturbances and chronic pain syndromes. Aging-related neurobiological changes such as impaired pain modulation, endothelial dysfunction and neuroinflammation may influence disease expression and treatment response.
Supporting source [1]
Treatment limits and research priorities in the review
The review states that therapeutic management is challenged by contraindications, increased susceptibility to adverse drug effects and the complexity of polypharmacy, highlighting individualized and non-pharmacological approaches. It concludes that migraine in older adults is a significant but often overlooked contributor to disability and reduced quality of life, and that better recognition of its unique clinical features and age-specific vulnerabilities is needed for patient-centered care. Future research should include older populations and develop tailored, safe and effective management strategies.
Supporting source [1]
How to interpret this
This is an abstract of a narrative review, not a systematic review or primary study; the full text was not reviewed. The abstract reports no search strategy, sample sizes, effect estimates or quantified uncertainty, so the described associations and burdens cannot be checked in detail here.
Based on the study abstract; the full paper, tables and supplementary data were not reviewed.
Source & supporting passages
Claudio Tana, Michalis Kodounis, Raffaele Ornello, Bianca Raffaelli, Roberta Messina, William Wells-Gatnik, Marta Waliszewska-Prosół, Simona Sacco, Dilara Onan, Paolo Martelletti · doi.org · April 17, 2026