Abstract
Background/Objectives Migraine is a common and debilitating condition characterised by recurrent headaches. Healthcare providers are treating more elderly patients with the condition due to increased life expectancy. Treatment options are affected by polypharmacy, intolerability of many preventative medications, and the vascular risk posed by abortives such as the triptans.
Novel therapies, such as ditans, gepants, and monoclonal antibodies targeting CGRP, show promise due to lack of vasoconstrictive properties and demonstrable clinical efficacy with triptans. This review examines the overall safety and efficacy of said therapies specifically in the elderly population.
Methods We conducted a review of trials found through PubMed and The Cochrane Library. Trials included ditans, gepants, and CGRP-directed monoclonal antibodies. Search terms included class and individual drug names. Subjects over 65 years old were classified as elderly, as per the most common age cut-offs in the studies. Parameters assessed included pharmacokinetics, clinical response to therapy as measured by reduction in monthly migraine days, and safety as measured by frequency of treatment-emergent adverse events (TEAEs). Trials included Phase 1 to 3 studies addressing elderly populations and post hoc analyses of larger trials. Larger trials without subgroup analyses were excluded from the review.
Results The results showed that novel therapies are as effective in the elderly and show similar rates of side effects as compared to younger patients. There was no demonstrable increase in vascular events.
Conclusion Novel migraines therapies may pose a safer and more tolerable alternative to current migraine treatment for the elderly.
