Abstract
Although secondary headaches due to e.g. temporal arteritis or a brain tumor are common among the elderly, primary headache disorders also occur in this age group, albeit less frequently than in younger individuals. A different presentation in the older age groups often makes a diagnosis difficult. Some headache syndromes, such as hypnic headache, are typical for the elderly. Furthermore, age-related physiologic changes, co-morbidities and contra indications require appropriate and targeted treatment in the elderly. Although treatments for the most common primary headaches are available, many limitations hamper their use in this group. For many headaches syndromes randomized controlled treatment trials in elderly are not available. In this article we review the clinical aspects of common primary headaches and medication overuse headache in the elderly and their treatments, with emphasis on age-specific problems. Relevance for patients: Primary headache syndromes in older patients ask for specific treatment considerations due to comorbidity, polypharmacy and an increased risk of side effects. Clinically, the headaches can be different and atypical. Results from clinical trials cannot be generalized to the elderly because these groups usually are not included in studies. In migraine, non-pharmacologic treatment should be considered, with depression and cerebrovascular disease as major comorbidities. Tension type headache, being the most common headache presentation in elderly, also includes a relatively large proportion of patients with a secondary headache warranting further testing. Trigeminal autonomous cephalalgias are rare, and can present with pseudo dementia. Medication overuse and medication-induced headaches are relatively common, for which patient education, ceasing drugs and withdrawal from caffeine containing substances are pivotal. Furthermore, hypnic headache, exploding head syndrome and benign thunderclap headache are specific for this patient group and require specific treatment.
Highlights
Primary headache disorders regularly occur in the elderly, albeit less frequently than in younger age groups, with reported prevalence ranging from 52%-81% [1,2]
In this article we review the clinical aspects of common primary headaches and medication overuse headache in the elderly and their treatments, with emphasis on age-specific problems
The elderly population is increasing in size in Western society, which results in a higher absolute number of elderly patients with headaches
Summary
Primary headache disorders regularly occur in the elderly, albeit less frequently than in younger age groups, with reported prevalence ranging from 52%-81% [1,2]. A higher calendar age does not always reflect a higher biological age, and the studies addressed in this review have used different age cut-offs for defining elderly patients (with ages above 50, 55, 60 or 65 years). We will discuss the clinical characteristics of primary headache syndromes in the elderly, as well as treatment options, pitfalls and caveats. Headaches induced by analgesics use suggest that these headaches are secondary, we have included the medication overuse headaches, since it is unclear why analgesics do lead to headaches in headache patients, but not in patients with other chronic pain conditions
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
