Although I have tried many of the traditional preventive treatments such as topiramate, propranolol, candesartan (esp if HTN), and amitriptyline (esp if insomnia), the results are variable at best. I believe that CGRP mab are safe in this situation and are probably the best option for episodic migra...

Although in the appropriate patient they would start with low-dose nortriptyline at night and build it up very slowly, I would consider blocking CGRP either Orally or by injection. There has been some concern about vascular activity of doing that; however, until they approve and unsafe in this categ...

I agree. Treat the headache type according to traditional preventatives. At this time, the theoretical concerns of vasospasm are still unanswered with the CGRP mab drugs so some will avoid them in the first 6 months after cardiovascular events. I agree with Botox if they meet criteria. 

I would do CGRP inhibitors PO or Injection or Botox. Chronic migraine management in the elderly is a special challenge. In this age group, antidepressant medications such as tricyclic, depressant drugs such as amitriptyline, nortriptyline (less) are not good choices since they cause anticholinergic...