Migraine prevalence increases from childhood up until 40 years of age, and thereafter declines. Several hypotheses can be advanced to explain the decrease in migraine with advancing age: (i) favorable effect of preventive treatments; (ii) increased mortality in migraineurs (due to higher vulnerability to other fatal diseases); (iii) cohort effect (increased incidence in young subjects); (iv) spontaneous remission. The first two theses are poorly supported by data in the literature. Although a cohort effect may exist, a spontaneous remission of migraine in middle and old age (at least partially due to the loss of sex hormone changes after the menopause in females) is the more likely hypothesis. In a small subgroup of patients (most of them drug abusers), migraine has a "malignant" course and changes into chronic daily headache. The risk factors for a poor outcome of migraine have been little studied. In a case-control study, we found that a history of head trauma and a long duration of contraceptive intake were risk factors for a bad outcome, whilst a long duration of prophylactic treatments had a protective effect.
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