Migraine in Older Adults: Age-Related Clinical Features From the Italian RICe Registry

Abstract

Background

Primary headaches, particularly migraine, are prevalent disorders insufficiently characterized in older adults. This multicentre study evaluated headache diagnoses, focusing on migraine, across age groups in headache centers participating in the Italian Registry for Headache Disorders (RICe).

Methods

Using a post hoc design, we evaluated 3477 patients enrolled at 30 headache centers (2019–2025). Patients were stratified into young adults (18–30 years), adults (31–45 years), middle-aged (46–59 years), and elderly individuals (≥ 60 years). Demographic and clinical migraine characteristics were collected. Group differences were assessed using χ² tests and Kruskal–Wallis ANOVAs.

Results

Of 3477 patients, 644 (18.5%) were elderly, 1285 (36.9%) middle-aged, 990 (28.5%) adults, and 558 (16.1%) young adults. Among migraine patients (n = 3013, 86.7%), diagnoses differed across age groups (χ²(6) = 71.5, p < 0.001). Elderly individuals more frequently had chronic migraine (CM) (z = 4.18), whereas migraine with aura was more common in young and adult patients (z = 3.62 and 4.97, respectively). Medication-overuse headache was more frequent in the elderly (z = 3.56), who reported more monthly migraine days but lower pain intensity and fewer severe attacks (all p < 0.02). Stress and physical activity were common triggers. Among patients with available treatment data, some differences in prior preventive treatment patterns were observed, with more frequent use of beta-blockers and onabotulinumtoxinA in the elderly, whereas anti-calcitonin gene-related peptide (CGRP) monoclonal antibody prescriptions did not differ across groups.

Conclusions

Older adults attending headache centers more frequently presented CM, with higher attack frequency, lower pain severity, greater medication overuse, and distinct triggers, supporting tailored diagnostic and therapeutic strategies.