New Gains to Ease Migraine

Improved treatments are changing the way this unique brain pain is managed

Jessica Migala, AARP

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En español

Published January 17, 2024

A woman with her eyes closed and hands on her temples as if she's having a migraine

Getty Images; Illustrations by Remie Geoffroi

It’s an exciting time to have a migraine. OK, maybe not really, but if you’ve struggled over the years with this unique breed of brain pain (as opposed to the more common and muscle-based tension headache), relief may finally be in sight.

To have a migraine brain is to have a highly reactive brain that does not respond well to changes in light, temperature, sound or even smell. Anything that triggers this increased sensitivity can cause your brain to start zipping off pain signals.

The headache can last up to 72 hours, but the full duration of an attack may be a week. For some, there is no headache at all, but other symptoms — flashes of light or bright spots, loss of sight, nausea, numbness or tingling — can mimic alarming, ER-worthy conditions.

In other words, don’t think of a migraine as a simple headache. “It’s a genetic neurologic disease,” says Nina Riggins, M.D., neurologist, headache specialist and president of the Brain Performance Center and Research Institute. There’s been a sea change as to how we speak about migraine — someone doesn’t “have migraines,” they experience “migraine,” an important distinction that speaks to the disruptive and disabling nature of this disease. At its heart, migraine may be the product of a more sensitized nervous system, though researchers are still trying to unfold the exact cause. “We think the central nervous system of migraine patients is more sensitive to lifestyle disruptions,” says Katherine Carroll, M.D., a neurologist with the Northwestern Medicine Comprehensive Headache Center in Chicago.

How migraine changes with age

One in 10 older adults experience migraine every year, according to research in the journal Neurology and Neuroscience. Symptoms evolve with age, especially for women after menopause, as the monthly rise and fall of hormones is a common trigger. (Women are two to three times more likely to experience migraine than men.) The headache, which in younger people often manifests as a pulsating ache on one side of the head, may shift to both sides of the head as a person ages, Riggins says. Older people are also less likely to be light- and sound-sensitive or to have other traditional migraine symptoms, such as nausea and vomiting.

“As people, particularly females, get older and hormones change after menopause, they may drop the headache altogether and their migraine may be aura-only,” says Barbara L. Nye, M.D., clinical associate professor in neurology at Wake Forest University School of Medicine. “Aura” refers to visual changes — flashes, bright spots, shapes, blind spots, or blurred or lost vision — that typically precede a headache. “You may be driving down your street and see a shimmer in your vision or partially blocked vision,” Nye says. Imagine the panic, since these can also be signs of a stroke. (See “When to See the Doctor”)

Powerful new treatment options

More than half of those with migraine say they’re constantly juggling treatments in search of the right one, according to 2021 data from the National Headache Foundation. Over the past five years, however, new therapies have emerged that are changing the way migraine is managed. Historically, the only therapies available were medications used for other diseases, such as seizure disorder, depression or high blood pressure, Nye says.

Though these remain viable and effective options, some are not safe for older adults with conditions such as heart disease. So it’s a relief that a number of new therapies, including drugs and devices, have been designed specifically to prevent and treat migraine — and many have proven to be better suited for older adults.

ORAL MEDICATIONS

The new generation of migraine drugs is called CGRP antagonists (or “gepants”). These drugs — rimegepant (Nurtec), ubrogepant (Ubrelvy) and atogepant (Qulipta) — block the action of a pathway, or connection of brain cells, involved in triggering migraine attacks. Typically, these are used “as needed” to treat a migraine in progress, but the Food and Drug Administration expanded the approval of Qulipta, allowing it to be used as a daily preventative for people who experience at least 15 headache days a month (called chronic migraine). Clinical trials on this group found that 41 percent of patients experienced at least a 50 percent reduction in their headache days every month when given one of three dosage levels, compared with 29 percent of those taking a placebo.

Gepants are an especially useful alternative for people who don’t respond to triptans, a more traditional migraine medication, and a safer type of drug for those with heart disease, a 2022 review suggests.

NASAL SPRAY

Zavegepant (Zavzpret), a gepant nasal spray used to treat migraine, can bring relief within 30 minutes. Approved by the FDA last year and launched over the summer, “the spray provides a quicker onset of action compared to oral rescue medications, which is good for patients whose migraines come on fast and severe,” Carroll says. (If you experience nausea and vomiting, this is a good option should you have trouble keeping down a pill.)

INJECTABLES

An icon for an injectable on a green background

Galcanezumab (Emgality), erenumab (Aimovig) and fremanezumab (Ajovy) are self-injected drugs, called CGRP monoclonal antibodies, that prevent the onset of an attack by blocking the migraine pathway. “We are using these for prevention, and they don’t usually interact with other medications,” Riggins says.

NEUROMODULATION

These wearable devices — five are FDA-cleared: Cefaly, SAVI, gammaCore, Relivion and Nerivio — stimulate nerves to help regulate nervous system function, which decreases migraine. “These can be an excellent tool to prevent and treat migraine. They’re considered safe devices, and many of my patients find them relaxing to use,” Nye says, although they can’t be used by people with pacemakers. Riggins says people often have to use both medication and neuromodulation, but these devices can cut down on the amount of meds they need to take.

GREEN LIGHT

Whereas blue light is agitating to the migraine brain, green light is considered to be brain-friendly. A small study in the journal Cephalalgia showed that green light exposure for one to two hours per day from 7.9 per month to 2.4 per month, on average. In those with chronic migraine, the green light cut headache days by more than half, according to this study. Green light may act on cells in your retina that alter your perception of pain. The Allay Lamp is a green light lamp developed by Harvard Medical School neuroscientist Rami Burstein specifically for migraine control. Other options include Gamma’s Soothe lamp, as well as green light bulbs from Hooga or Norb.

When to See the Doctor

“Head pain is an indication from your body saying something isn’t right,” says neurologist Barbara L. Nye, M.D. If you develop headaches (they’ve just started, are more prevalent or come with different symptoms than before), that’s a sign that you should talk to your doctor for a workup to check out what may be going on, she says. Head pain in older adults can be a sign of an underlying health condition such as sleep apnea, or medication interactions. If you’re suddenly struck with the worst headache of your life or experience weakness, numbness or a change in vision that comes on quickly, seek emergency care. These can be signs of a brain aneurysm or stroke.

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