June is Migraine Awareness Month. Migraine is a hereditary, debilitating neurological disease afflicting 38 million people in the United States, and one billion people worldwide. Like many ‘invisible illnesses,’ migraine leaves sufferers looking ‘normal’ even though it is the sixth most disabling illness in the world. A quarter of U.S. households include someone who suffers from migraines and it’s the third most common illness, globally. Everyone knows someone who suffers from migraine, or is themselves a migraine sufferer, and yet it is one of the least understood diseases. Caregivers, home care aides and loved ones need to know the ways that migraine touches all of us.

Most migraineurs (a migraine sufferer) have attacks once or twice a month, but more than four million adults have chronic daily migraine, meaning they endure a migraine 15 days out of every 30. Some chronic migraine sufferers have a migraine every single day. Nearly 1.2 million American emergency room visits each year are caused by acute migraine attacks. Migraine is invisible to the naked eye, but treating migraine is estimated to cost the United States as much as $36 billion per year in lost productivity. Migraine sufferers spend 70% more on healthcare, risk losing employment over sick days, and risk other, concomitant physical and psychological conditions while enduring severe pain.

Migraines are three times more common in women than in men, and most common between ages 30 and 40. There are as many triggers as there are migraineurs – weather changes, stress, perfume or strong odors, bright lights, excessive heat, spices or food additives, cigarette smoke, to name a few – but hormone level fluctuations are a common factor for pre-menopausal women. After menopause, only twice as many women as men have migraine, and frequency continues to decrease with age, so that only 5% of women and 2% of men over 70 still experience migraine. So, while older people have fewer migraines than younger people, there are some seniors who continue to experience migraine no matter what their age. These senior sufferers typically experienced their first migraines in their teens and twenties, 90% have their first attack before age 40, and this small percentage continues to suffer migraine into their 80s and beyond.

It is very unusual, though possible, for someone over 60 to get a migraine for the very first time, and often migraine-like symptoms at this age indicate some other condition manifesting itself. As migraine sufferers age, their symptoms tend to shift to aura without headache pain, or the usual symptoms lessen in severity and frequency. Senior migraineurs should be aware that new symptoms can signal serious non-migraine problems. Unusual headaches in older people could also be:

Migraineurs often develop other conditions along with their debilitating neurological disease. People with migraine are more likely to suffer depression as well, and any incidence of major depression makes it more likely that the migraines will continue into older age. Migraine with aura correlates with a high risk of cardiovascular disease, but an insignificant risk of stroke for those over 50. However, while migraine with aura causes brain lesions, there is ultimately no connection between migraine and cognitive impairment.

Treatment of migraine later in life is tricky because older people often develop medical conditions that prevent use of the migraine medications that used to work for them. Sometimes, these medications can cause headaches on their own. Migraines at any age are debilitating, excruciating, and persistent, and while a large majority of seniors ‘age out’ of them, a small percentage doesn’t.