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Headache disorders in the elderly

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Opinion statement

  • Headache prevalence declines in the elderly, but remains a common reason for patients to seek medical attention. Although primary headache types remain most frequent, secondary headaches become more likely in this age group. Accurate diagnosis is essential, and the clinician should maintain a lower threshold for ordering laboratory testing and neuroimaging.

  • The elderly are more likely to have co-existent medical conditions, which present both therapeutic limitations and opportunities when selecting acute and preventative treatments for headache.

  • Altered pharmacokinetics and pharmacodynamics in this age group may increase the likelihood of side effects and drug interactions. Downward dose adjustments and simplifying medication regimens are often appropriate, as is using nonpharmacologic therapies whenever possible.

  • Due to frequent contraindications related to acute medications, preventative drug regimens and nonpharmacologic treatments assume greater prominence when treating the elderly suffering frequent/severe headaches.

  • Medication-induced headache and analgesic rebound headache occur commonly in this age group and may initiate, aggravate, or perpetuate headache. Chronic daily headache is often due to these conditions, and recognition of these problems can allow effective intervention.

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References and Recommended Reading

  1. Solomon GD, Kunkel RS, Frame J: Demographics of headache in elderly patients. Headache 1990, 30:273–276.

    Article  PubMed  CAS  Google Scholar 

  2. Lipton RB, Pfeffer D, Newman LC, et al.: Headaches in the elderly. J Pain Symptom Manag 1993, 8:87–97.

    Article  CAS  Google Scholar 

  3. Edmeads J: Headaches in older people: how are they different in this age group? Postgrad Med 1997, 101:91–100.

    PubMed  CAS  Google Scholar 

  4. Edmeads J: Headache in the Elderly. In The Headaches, edn. 2. Edited by Olesen J, Tfelt-Hansen P, Welch KMA. Philadelphia: Lippincott, Williams, and Wilkins; 2000:947–951. A thoughtful and comprehensive review of the diagnosis and management of headache in the elderly.

    Google Scholar 

  5. Silberstein SD, Lipton RB, Goadsby PJ: Headache in Clinical Practice. Oxford: Isis Medical Media; 1998:201–212.

    Google Scholar 

  6. Ward TN: Headache in cerebrovascular disease. In Office Practice of Neurology. Edited by Samuels MA, Feske S. New York: Churchill Livingstone; 1996:1141–1144.

    Google Scholar 

  7. Fisher CM: Late-life migraine accompaniments as a cause of unexplained transient ischemic attacks. Can J Neurol Sci 1980, 7:9–17.

    PubMed  CAS  Google Scholar 

  8. Pascual J, Berciano J: Experience in the diagnosis of headaches that start in elderly people. J Neurol Neurosurg Psychiatry 1994, 57:1255–1257.

    Article  PubMed  CAS  Google Scholar 

  9. Prencipe M, Casini AR, Ferretti C, et al.: Prevalence of headache in an elderly population: attack frequency, disability, and use of medication. J Neurol Neurosurg Psychiatry 2001, 70:377–381.

    Article  PubMed  CAS  Google Scholar 

  10. Headache Classification Committee of the International Headache Society: Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 1988, 8(suppl):1–98.

    Article  Google Scholar 

  11. Ward TN: Management of an acute primary headache. Clin Neurosci 1998, 5:50–54.

    PubMed  CAS  Google Scholar 

  12. Mathew N, Schoenen J: Acute pharmacotherapy of tension-type headache. In The Headaches, edn 2. Edited by Olesen J, Tfelt-Hansen P, Welch KMA. Philadelphia: Lippincott, Williams, and Wilkins; 2000:661–666. This chapter is a very thorough review of treatment studies and practical treatment options.

    Google Scholar 

  13. Physicians’ Desk Reference. Montvale: Medical Economics Company; 2002.

  14. Silberstein SD: Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000, 55:754–762. A masterful review of what is known about migraine therapy, using an evidence-based format. It reviews guidelines for imaging, and the use of nonpharmacologic, acute, and prophylactic therapies.

    PubMed  CAS  Google Scholar 

  15. Ward TN: Providing relief from headache pain. Postgrad Med 2000, 108:121–128.

    PubMed  CAS  Google Scholar 

  16. Mathew N, Bendtsen L: Prophylactic pharmacotherapy of tension-type headache. In The Headaches, edn 2. Edited by Olesen J, Tfelt-Hansen P, Welch KMA. Philadelphia: Lippincott, Williams, and Wilkins; 2000:667–673. A clear and thorough review of relevant studies and treatment options.

    Google Scholar 

  17. Jensen R: Tension-type Headache. Curr Treat Options Neurol 2001, 3:169–180. An up-to-date review of what works and what doesn’t work in the treatment of tension-type headache.

    PubMed  Google Scholar 

  18. Anthony M: The role of the occipital nerve in unilateral headache. In Current Problems In Neurology: Advances In Headache Research. Edited by Rose FC. London: John Libbey; 1987:257–262.

    Google Scholar 

  19. Silberstein S, Mathew N, Saper J, et al.: Botulinum toxin type A as a migraine preventative treatment. Headache 2000, 40:445–450.

    Article  PubMed  CAS  Google Scholar 

  20. Relja M, Korsic M: Treatment of tension-type headache by injections of botulinum toxin type A: a doubleblind placebo-controlled study. Neurology 1999, 52(suppl):A203. Thought provoking study suggesting efficacy for this novel treatment.

    Google Scholar 

  21. Smuts JA, Baker MK, Smuth HM, et al.: Botulinum toxin type A as prophylactic treatment in chronic tensiontype headache. Cephalalgia 1999, 19:454. Well-designed, interesting study.

    Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, Dartmouth Medical School, One Medical Center Drive, 03756, Lebanon, NH, USA

    Thomas N. Ward MD

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  1. Thomas N. Ward MD
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Ward, T.N. Headache disorders in the elderly. Curr Treat Options Neurol 4, 403–408 (2002). https://doi.org/10.1007/s11940-002-0051-z

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