How migraine feels can change as you age. You don’t “grow out of them,” but as your hormones change, so can your symptoms.
“For many people, migraine improves as they get older,” says Jaclyn Rosencutter Duvall, MD, a neurologist at Headache Specialists of Oklahoma in Tulsa, Oklahoma. “Attacks often become less frequent and severe, especially after menopause, when hormone levels stabilize. Some people may still have headaches, but they often change in pattern or become easier to manage.”
But that’s not true for everyone. Many factors can cause your migraine attacks to worsen as you get older. Here’s why it happens and what you can do about it.
Common Health Conditions That Worsen Migraine
More than 75 different conditions are linked to migraine. You’re at a higher risk of many of these health issues as you age, including:
High blood pressure. The health of your blood vessels can affect your brain. Research shows that a high diastolic blood pressure (the lower number, which measures the pressure in your heart between beats) can raise your risk for migraine.
Atherosclerosis. As you age, your blood vessels can become stiff and hard, a condition known as atherosclerosis. “This doesn’t play a role in migraine severity or recovery time,” Duvall says. But atherosclerosis is one factor that can make migraine more likely.
Obesity. A body mass index (BMI) of 30 or higher (23 or higher if you’re of Asian descent) could cause migraine attacks to become more frequent. Excess fat cells may increase inflammation and pain-making hormones, which could also make a migraine attack feel more intense.
Diabetes. Insulin resistance (when your body doesn’t respond well to insulin) has been linked to migraine, including how long an attack lasts. Your brain needs steady amounts of glucose to function well, so low blood sugar (hypoglycemia) can be a migraine trigger.
Thyroid disorders. Thyroid hormone helps your body change fats and sugars into fuel. If you don’t make enough, you have a condition called hypothyroidism. Women are 10 times more likely than men to have it. Hypothyroidism can make painful migraine attacks more likely, even after your thyroid hormone levels return to normal.
Sleep disorders. Experts believe that while you sleep, your brain flushes out toxins that gather during the day. If you don’t get enough rest due to a condition like sleep apnea or insomnia, those toxins could build up and make migraine more likely.
Steps to Stay Healthy
You may be able to prevent some of these health conditions if you:
Make time to exercise. Aim for 30 minutes a day, five days a week, of moderate activity such as biking or brisk walking.
Manage your stress. Tension can affect your entire body, especially if you live with it for a long time. Talk to a mental health counselor if you need new coping strategies.
Eat healthy foods at every meal. Focus on more fresh vegetables and fruits, whole grains, dairy products, and lean protein like beans, eggs, chicken, and tofu. At the same time, try to limit added sugars, saturated fats, and foods high in sodium and cholesterol.
Limit processed foods. Instead of foods that come in a bag or box, choose fresh, whole foods as much as you can.
Cut out tobacco and alcohol, especially close to bedtime. Talk to your doctor if you need advice on how to quit.
See your doctor regularly. Even if you’re feeling well, it’s important to get regular checkups. Based on your age, your doctor may screen you for certain health conditions. Based on your results, your doctor may also decide to change your migraine treatment.
How Migraine Triggers Evolve
Over time, your migraine triggers can change. You could become sensitive to something that never bothered you before, or a previous trigger could suddenly stop bothering you.
One study of just over 1,000 people found that stress became less of a migraine trigger with age, while drinking alcohol, smoking, and neck pain became more frequent triggers.
Still, “it’s not very common for people to develop new triggers, although postmenopausal women can see this occur,” says Joshua T. Mendelson, MD, a board-certified neurologist at Monmouth Medical Center in Long Branch, New Jersey.
Hormones and Migraine
“Hormonal fluctuations are among the most powerful migraine triggers for women with migraine,” Duvall says. “Migraine tends to peak during the reproductive years.”
Changing levels of estrogen and progesterone make migraine attacks more likely. About 60% of women notice a link between migraine and their periods.
As you get older, you’ll go through:
Perimenopause. Your hormones start to drop as you prepare to exit your childbearing years. Perimenopause usually starts when you’re around age 40 and can last up to 10 years.
“Perimenopause can be an especially difficult time with unpredictable and dramatic shifts in estrogen levels, often leading to more frequent and severe attacks,” Duvall says.
Your migraine attacks could also get harder to treat.
Menopause. After you’ve gone 12 months without a period, you’re in menopause. As your hormones level out, your migraine attacks may become less frequent. That may be more likely to happen if your perimenopausal migraine attacks were managed well with medication and you follow lifestyle advice from your doctor.
Your migraine attacks may stop for good after menopause, but that’s not true for everyone.
“I use the rule of 1/3’s,” Mendelson says. “As in, 1/3 get better, 1/3 stay the same and 1/3 get worse.”
How Aging Affects Migraine
Migraine is linked to changes in both your brain structure and how it functions. Imaging scans show that your brain may also age faster than someone who doesn’t live with migraine.
“As you age, your brain’s excitability and neurotransmitters can change,” Duvall says.
One of these neurotransmitters, serotonin, plays a key role in migraine.
“[Serotonin] levels tend to decrease with age, which can change how migraine presents – often fewer headaches but more aura or what we call ‘late life migraine accompaniments,’” Duvall says.
You could also have:
- Pain on both sides of your head, instead of one
- Less sensitivity to light and/or sound
- More attacks at night or early morning
- Vision changes and less head pain
Does it take longer to get over a migraine attack when you’re older?
“The ability to recover from a migraine shouldn’t worsen as we age,” Mendelson says. But your doctor may choose different treatments for you as you get older.
Other Reasons Your Migraine Gets Worse With Age
“While true migraine attacks often lessen as women age, other types of headaches can appear and sometimes make it seem like migraine has worsened,” Duvall says.
Among them are headaches due to:
- Neck and spine arthritis
- Chronic pain conditions
- Rebound or medication-overuse
- Medication side effects
Rarely, you can have an intense headache that’s due to a serious health reason, such as:
- Postherpetic neuralgia (nerve pain after having shingles)
- Giant cell arteritis (inflamed arteries)
- Stroke
- Heart attack
Migraine is unlikely to start after the age of 50. If you have migraine pain for the first time, or you’re over the age of 60 and your migraine feels different than usual, see a doctor. An early diagnosis can help you start treatment and avoid severe complications.
When to Seek Immediate Help
Get to a hospital or call 911 if you have:
- A “thunderclap headache,” a very painful headache that comes on suddenly
- A headache that won’t go away and gets worse when you exercise, cough, or make a sudden movement
- A headache after a head injury
Signs of stroke
A stroke happens when blood flow to your brain gets blocked by a clot or damaged blood vessel. It’s a medical emergency, and if it happens, you need to act fast.
“BE FAST” can help you remember the warning signs of stroke:
- Balance problems, such as not being able to stand
- Eyesight changes, such as blurry or double vision
- Face changes, such as drooping on one side
- Arm weakness, such as not being able to lift one arm
- Slurred speech or trouble choosing words
- Time is crucial for treatment. Call 911, then look at a clock so you can tell first responders the time that the symptoms began.
Managing Migraine as You Age
Remember: “Migraine is dynamic and can change over time,” Duvall says. Everyone goes through periods when they feel worse.
“The good news is that there are excellent newer treatments available that are safe and effective. With the right care, healthy routines, and support, things can and usually do get better,” Duvall says.
