Treating acute migraine attacks in elderly people

Introduction-Purpose: Migraine or "morbid headache" derives from the Greek word that means "pain of half of the head". It attacks at least one out of ten people, it is more frequent among women, and it affects mostly persons aging between 20 and 50 years old. Acute migraine attacks are rare over the age of 50. Tyrical clinical characteristics of migraine are the following: (in outset) paroxysmic; (in position) frontotemporal location (heterolateral) with postorbital or occipital reflection; (in quality) intense-pulsating; (in duration) 4 up to 72 hours (average 6-8 hours). Migraine attacks usually terminate automatically. Stress is the most frequent triggering factor. The purpose of the present essay is to approach migraine attacks using a random sample of elderly people in a therapeutic manner.

Population-Methods: Ninety-three elderly patients were subjected to treatment as a result of a migraine attack. At first, they were separated into three age groups, equal in number (A, B, C, -n=31 each) based on the therapeutic treatment protocol. Teams were structured following their matching with respect to age, sex, body mass index (BMI) and their accompanying diseases. Team A was administered=Diclofenac 75 mg or Paracetamol 500 mg i.m. + Inhaling O2 40%, Team B=Dextropropoxyphene 75 mg or Pethidine 50 mg i.m. + Inhaling O2 40% and Team C=Inhaling O2 40% + Diazepam 10 mg i.m. Total time for the improvement of clinical symptomatology (TICS) was reported. Any reported improvement >=50% of the initial pain was considered a significant improvement of clinical symptomatology (SICS). Constant parameters were expressed as average rates (AVG), with stable deviation (±SD). Matching of elderly patients into groups was achieved using Data Base Access 2003. The x2 method was used for the statistical analysis of quality observations. The Student’s t-test was applied to quantity observations. The p value (probability) <0,05 was considered as the limit of statistical significance. any other probability (p) >0,05 was considered statistically non-significant.

Results: Following the analysis of the available SICS data, the following results were obtained: Team A=17,8±3,1 min. team B=13,4±0,7 min (p=0,003), Team C=39,6±10,8 min (p<0,002). Similarly, the difference in SICS between Team B and C (p<0,001) was statistically significant. Twenty-four patients (77,4%) from Team A (>=50%) reported SICS as a result of administration of the aforementioned therapeutic protocols. the respective percentages for Team B was 100% (31 patients-p<0,0001) and 21 (67,7%-p<0,0004) patients from Team C. Similarly, the difference in SICS between Team B and C (p<0,001) was statistically significant. side effects reported with respect to Team A involved 12,9% (4 elderly patients) and considered primarily in intestinal disturbances. Nine (29%) patients from Team B and three (9,6%) from Team C were diagnosed with (temporary) sleepiness.

Conclusions: Distribution of acute migraine attacks among elderly female patients presented to hospital was higher. The most frequent type of acute migraine attacks in elderly patients was common migraine (without aura). The therapeutic protocol used in Team B seemed to have secured a significantly faster pain relief (as opposed to the other two), irrespective of type, clinical characteristics or possible triggering etiology. TICS rates were highest (100%) among patients from Team B. Fewer side effects from the application of therapeutic schemes were observed among elderly patients of Teams A and C. Therapeutic schemes applied to the elderly patients of our essay, even though known for a number of years, appeared not to be inferior with regard to TICS when compared against later therapeutic drugs. Their only "disadvantages" is parenteral administration (i.m.), contraindications and side effects.

Key words: Migraine, elderly patients, treatment management.