Migraine is a common, disabling neurological disorder that affects those of all age groups, including older adults, though its incidence and prevalence decrease with age. In the elderly, migraine appears to be more often bilateral. Most headaches in elderly patients will likely be the result of a primary headache disorder such as migraine or tension-type headache. However, it is important to exclude secondary headache disorders, such as giant cell arteritis, in this patient population. Additionally, polypharmacy and the presence of multiple comorbidities are both often seen in older adults. Age-specific pharmacodynamics and pharmacokinetics complicate matters yet further, and vascular issues such as transient ischemic attacks (TIAs), amyloid angiopathy, and late-life migraine accompaniments (LLMA) create additional problems.