Introduction
June marked Headache Awareness Month, an important opportunity to highlight often-overlooked issues in older adults, such as migraine and chronic headache disorders. As a general dentist, you may be surprised to learn that your patient population over 60 could be suffering from undiagnosed or mismanaged headache conditions, often mistaken for tension-type headaches or dismissed as part of aging. These symptoms can significantly impact oral health, prosthetic tolerance, and treatment outcomes. Understanding the intersection of orofacial pain and systemic health in aging populations positions dental professionals at the forefront of collaborative care.
Understanding Migraine in Older Adults When to Be Concerned: Ruling Out Secondary Headache
In older adults, it’s especially important to distinguish between primary headache disorders and secondary causes that may signal underlying pathology. The American Migraine Foundation outlines several red flags that should prompt immediate referral for neuroimaging or further evaluation:
Red flags include
- Sudden onset or “thunderclap” headache
- New headache in a patient over 50
- Headache with neurological signs or systemic symptoms (fever, weight loss)
- Headache that worsens with exertion or changes in position
- Headache in immunocompromised patients or those with cancer [1]
These signs may indicate more serious conditions such as stroke, giant cell arteritis, or brain tumors. Dental professionals should be vigilant and prepared to refer patients promptly when these features are present.
Though migraine prevalence typically peaks in the 30s, chronic migraine can persist or even worsen in older adults. Migraine in this age group often presents atypically, such as with bilateral pain or without the classic throbbing quality, making diagnosis challenging [2]. Additionally, migraine aura becomes more common with age and may mimic or be confused with vascular events or neurodegenerative symptoms, complicating diagnosis and treatment.
Common migraine symptoms include moderate to severe throbbing pain, nausea or vomiting, sensitivity to light and sound, and aura (visual or sensory disturbances that precede the headache). Migraine with aura is more frequently observed in older adults and can sometimes occur without the headache phase, further complicating recognition.
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The Link Between Migraine, Cognitive Decline, and Aging
Emerging evidence suggests that chronic migraine and headaches are associated with an increased risk of Alzheimer’s disease and related dementias [3]. Chronic pain alters brain morphology and disrupts networks critical to cognitive function. These neurological changes can begin subtly, but in older adults with longstanding migraine or frequent headaches, cognitive deficits can become clinically relevant.
The Gut-Brain Axis: A Systemic Perspective
An often-overlooked dimension in migraine pathophysiology is the gut-brain connection. Gastrointestinal comorbidities such as irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and gastroparesis are prevalent in patients with episodic and chronic migraine, and these disorders tend to intensify with age [4]. Poor oral intake due to nausea or motility issues can affect nutritional status, immune response, and even oral tissue resilience. Dental professionals should be aware that medications affecting GI function, including NSAIDs and certain triptans, may have implications for both migraine management and oral health.
Furthermore, gastrointestinal issues often complicate the administration of oral migraine medications. The American Headache Society recommends nonoral treatment options such as nasal sprays, injectables, or transdermal therapies for patients with severe nausea or vomiting, which are common in migraine attacks. Dentists should be aware of these treatment modalities when discussing medication adherence or evaluating systemic health complaints.
Why Should Dentists Care?
Older adults frequently present with overlapping symptoms of orofacial pain, temporomandibular disorders, and systemic headache conditions. Dentists are in a unique position to identify red flags during routine exams. For example, a patient complaining of frequent bilateral jaw pain, photophobia, and nausea could be experiencing migraine rather than a purely dental or muscular condition. Understanding the nuances of geriatric migraine supports accurate referral pathways and patient education.
In addition, migraine and headache-related discomfort can impair prosthetic adaptation and occlusion, leading to diminished quality of life. Early recognition and appropriate referral not only alleviate suffering but also support successful dental rehabilitation and maintenance.
Geriatric Dentistry at USC
At the Herman Ostrow School of Dentistry of USC, the Geriatric Dentistry Master’s Program is designed to prepare dental professionals for precisely these complex interdisciplinary challenges. The program offers training in aging physiology, pain management, pharmacology, and patient-centered care strategies for medically and cognitively vulnerable adults. Participating in this program equips you with the tools to advocate for your patients’ holistic wellbeing.
Conclusion
Headache Awareness Month is a timely reminder that general dentists play a critical role in recognizing and addressing migraine in older adults. By becoming better informed and engaging in interdisciplinary education, such as the Geriatric Dentistry Master’s at USC, dental professionals can elevate the standard of care and improve outcomes for our aging population.
Postgraduate Geriatric Dentistry
Are you looking for improved ways to diagnose, treat, and manage the oral healthcare of older patients? Explore our online master’s and certificate program in Geriatric Dentistry.
References
- American Migraine Foundation. (n.d.). Migraine and Headache Awareness Checklist. Retrieved from https://americanmigrainefoundation.org
- Hugger, S. S., Do, T. P., Ashina, H., Goicochea, M. T., Jenkins, B., Sacco, S., … & Ashina, M. (2023). Migraine in older adults. The Lancet Neurology, 22(10), 934-945. https://doi.org/10.1016/S1474-4422(23)00206-5
- Innes, K. E., & Sambamoorthi, U. (2020). The potential contribution of chronic pain and common chronic pain conditions to subsequent cognitive decline, new onset cognitive impairment, and incident dementia: A systematic review and conceptual model for future research. Journal of Alzheimer’s Disease, 78(3), 1177-1195. https://doi.org/10.3233/JAD-200960
- Nguyen, L., Hindiyeh, N., Ray, S., Vann, R. E., & Aurora, S. K. (2023). The gut-brain connection and episodic migraine: An update. Current Pain and Headache Reports, 27, 765–774. https://doi.org/10.1007/s11916-023-01175-6
