OC-06 | Migraine in the elderly: a retrospective study in a tertiary headache center

Giulia Paparella,^1,2 Stefania Scannicchio,¹ Annalisa Di Dio,¹ Emmanuella Ladisa,¹ Chiara Abbatantuono,¹ Elena Ammendola,¹ Katia Ricci,¹ Giusy Tancredi,¹ Livio Clemente,¹ Marianna Diletta Delussi,³ Marina de Tommaso¹ | ¹Neurophysiopathology Unit, Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari; ²IRCCS Neuromed, Pozzilli (IS; ³Department of Education, Psychology, Communication (For.Psi.Com.), University of Bari Aldo Moro, Bari, Italy

Background: While nausea and vomiting are established migraine symptoms, evidence suggests that vomiting may possess potential therapeutic properties. Although literature data and anecdotal patient reports indicate pain cessation following emesis, a more careful characterization remains to be conducted. Knowledge gaps persist regarding temporal dynamics of migraine pain relief upon vomiting, distinctions between the effects of spontaneous versus self-induced vomiting, and the durability of the referred analgesic effects. The present exploratory analysis aims to further characterize the vomiting-pain relationship in migraine patients.

Methods: We conducted a cross-sectional survey of 106 adult migraine patients referred to our headache center. Pain intensity was assessed using Numerical Rating Scales (0-10) comparing attacks with and without vomiting. Due to non-normal distribution of pain intensity data, statistical analysis employed Mann-Whitney U test for pain intensity comparisons and chi-square tests for categorical associations. Evaluation included self-reported temporal onset patterns of pain relief, duration and magnitude of improvement, pain recurrence characteristics, and voluntary vomiting induction behaviors.

Results: Among 106 patients, 82 (77.4%) reported vomiting during migraine attacks. Attacks with vomiting showed significantly higher pain intensity compared to those without (median 9 vs 7, p< 0.001). Pain reduction following vomiting occurred in 54.9% of patients (45/82), with temporal distribution: 28.9% within seconds, 40% within minutes (range 2-40 minutes, median 15), and 31.1% within hours. Among patients experiencing initial pain relief, 73.3% (33/45) reported subsequent pain recurrence, though 57.6% described reduced intensity compared to pre-vomiting levels. Voluntary vomiting induction was practiced by 26.8% of patients (22/82), with significantly higher prevalence among those experiencing pain reduction (40% vs 10.8%, χ² = 7.388, p = 0.007).

Conclusion: This exploratory study provides a preliminary characterization of the relationship between vomiting and pain modulation in migraine, addressing previously understudied aspects such as timing, magnitude, recurrence, and patient behaviors. Additional preclinical and clinical studies are needed to elucidate the potential neurobiological mechanisms underlying vomiting-associated analgesia and to clarify its relevance in migraine pathophysiology.