Neurol. praxi. 2025;26(6):472-476 | DOI: 10.36290/neu.2025.046

Migraine treatment in seniors and patients with cardiovascular disease

MUDr. Petr Mikulenka¹, PharmDr. Markéta Pitrová², MUDr. Jolana Mračková, Ph.D.³, prof. MUDr. Ivana Štětkářová, CSc., MHA¹

¹ Neurologická klinika 3. LF UK a FNKV, Praha

² Oddělení klinické farmacie FNKV, Praha

³ Neurologická klinika LF UK a FN Plzeň

Migraine is a common neurological disorder that also affects seniors, despite its preva­lence decreasing with age. Even in this population, it can significantly impact quality of life and complicate the management of comorbidities. The clinical presentation of migraine in older patients often differs - attacks tend to be less frequent and milder, may be bilateral, and accompanying symptoms such as photophobia or phonophobia occur less frequently. A major diagnostic challenge is distinguishing aura without headache from a transient ischemic attack (TIA). Migraine treatment in seniors requires an individualized approach, considering pharmacokinetic and pharmacodynamic changes, polypharmacy, and comorbidities. In acute therapy, paracetamol is preferred, and for patients with cardiovascular risks, gepants are now recommended as a safer alternative to triptans. Preventive treatment includes beta-blockers, antiepileptics, antidepressants, angiotensin II receptor antagonists, and CGPR - targeted therapies (monoclonal antibodies and gepants). Modern treatment approaches expand the possibilities for effective and safe therapy even in this age group.

Keywords: migraine, seniors, cardiovascular risks, polypharmacy, gepants, triptans, monoclonal antibodies against CGRP.

Received: March 9, 2025; Revised: May 19, 2025; Accepted: May 19, 2025; Prepublished online: May 19, 2025; Published: December 15, 2025  Show citation