The Clinical Analysis About The Patients With Late-onset Migraine

Objective:In this study the difference of migraine in clinical features between the elderly (>45 years old) and the younger migraineous (20 to 45 years old) were compared in order for a better comprehension of the late-onset migraine, as well as to refine the recognition of the disease.Methods:40 cases of late-onset migraine were chosen from March,2009 to February,2011 in Shandong Provoncoal Hospital in this study. At the same time, 280 individuals with migraine aged 20 to 45 years were obtained.40 cases were selected randomly from the younger migraineous, as controls. Headaches were classified according to the Second Edition of the International Classification of Headache Disorders (ICHD-2). Individuals with other primary headaches as their main diagnosis were excluded. We also excluded those where a secondary headache had not been excluded at the time of chart review. Each patient received a clinical interview of neurology expert. The data of clinical presentation and laboratory finding were analyzed retrospectively. Interrelated disorders including intracranial hypertension, hypertensive headache and headache epilepsy and so on were eliminated in the diagnosis of migraine. The clinical features and treatment of migraine were compared in patients at different ages.Results:①Region of headache attack:strictly bilateral were found in 17 cases (47.2%) in late-onset migraine group, and 6 cases (16.2%) in controls (P<0.05). Global headache was found in 9 cases (22.5%) in the late-onset migraine group, while only 2 cases (5.0%) were found in the young headache group. More severe headache in frontal area was found in 7 cases (17.5%) in the young group vs 2.5%(1 case) in the late-onset group.②Associated symptoms:during headache attacks more often paleness 35.0%, dry mouth (35.0%), anorexia (25.0%) were found in late-onset migraine group, while paleness(12.5%), dry mouth (7.5%) and anorexia (7.5%) were found in the young group. Symptomatic treatment of migraine in the elderly was paracetamol, in the young group was ergotine. Prophylactic treatments in the two groups were calcium channel antagonist.③Duration time:Duration from 4 to 12 hours was found in 37.5% of the elderly and 15.0% of the controls (P<0.05).Conclusion:Migraine is less typical in the elderly and more frequently associated with vegetative symptoms. Therefore, the diagnosis of migraine in elderly subjects may be more challenging, and many patients with this primary headache may be misdiagnosed. Treatment of migraine presents special problems in the elderly. Co-morbid diseases may prohibit the use of some medications. Moreover, older patients are likely than younger ones to develop adverse events. Managing older migraine patients should consider the possible pharmacological interactions associated with the use of drugs for concomitant diseases in the elderly.