An illustration of a migraine.

M igraines—recurring headaches that can cause throbbing and sometimes debil­it­at­ing pain on one or both sides of the head—may pose particular challenges as we age.

more on headaches

These headaches, which are sometimes mistaken for sinus headaches, tend to decrease later in life. But they remain fairly common: Government statistics suggest that about 7 percent of people ­between ages 65 and 74 report having migraines or severe headaches.

For seniors, symptoms may be confusing—different from what they were earlier in life, for instance. Or what seems like a ­migraine could be another problem.

Also, certain medications that older adults often take—such as calcium channel blockers, nitroglycerine, erectile dysfunction drugs, and hormone treatments—can cause headaches. And some migraine drugs may be inappropriate for ­seniors. Here, the lowdown.

When New Symptoms Arise

Typical migraine symptoms include nausea, vomiting, and sensitivity to light and noise that accompany a throbbing or pulsating pain at the temples or front or back of one or both sides of the head. About 15 percent of people with ­migraines exper­i­ence auras beforehand. These usually include visual changes such as flashing lights and blind spots but can involve changes in hearing and smell.

While symptoms can differ from person to person, most people will develop a headache pattern over time, says Lawrence Newman, M.D., director of the headache division at NYU Langone Health medical center in New York City.

But some migraine sufferers might ­begin to experience unusual symptoms after age 50, called late-life migraine accom­pa­ni­ments. Migraines can ­occur without head pain and might ­include blurred vision, numbness or tingling in the limbs, and slurred speech. Such symptoms usually resolve on their own within 15 to 60 minutes and aren’t serious, Newman says, but they are uncomfortable.

Migraine or Another Problem?

If you haven’t had migraines in the past but think you are having them now, it’s a good idea to talk to your doctor. The likelihood that a serious health condition might be at fault ­increases significantly in those 65 and older. For instance, retinal detachment, transient ischemic attacks (ministrokes), stroke-related bleeding in the skull, and giant cell arteritis (inter­rupted blood flow, often in the vessels of the skull)—which are all medical emergencies—can cause migraine-type headaches or ­migraine auralike symptoms.

“If you’re experiencing the ­onset of a new type of headache or new symptoms—visual impairment, problems with speech, or severe head pain that comes on like a thunderclap—call your primary care doctor," says Richard Lipton, M.D., director of the Montefiore Headache Center in the Bronx, N.Y. "If you can’t be seen immediately, go to the emergency room,” 

To help rule out a problem that ­requires emergency treatment, the doctor will ask a series of questions—where you feel the pain, for how long, and what activ­it­ies preceded the headache—and may recommend an MRI. He or she should also check your current medicines to deter­mine whether any could be causing head pain. If the doctor finds that ­migraines are at fault, ask which treatment options are best for you.

Treating the Pain the Right Way

For occasional mild to moderate pain, try an over-the-counter pain reliever, says Carl Olden, M.D., a family physician in Yakima, Wash. Prescription triptans—such as sumatriptan (Imitrex and generic), naratriptan (Amerge and generic), and rizatriptan (Maxalt and generic)—are standard for severe migraines, but avoid them if you’re at high risk for cardiovascular disease.

Three portable prescription devices are approved to prevent or treat migraines: Cefaly, GammaCore, and SpringTMS. (Insurance doesn't always cover these.) And while a variety of preventive drugs are available, this year erenumab-aooe (Aimovig), the first of a new class of such drugs, was approved.

Editor's Note: A version of this article also appeared in the October 2018 issue of Consumer Reports On Health.