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J Clin Outcomes Manage
2011 Aug;18(8):371-382
Headaches in older individuals: diagnosis and management in primary care
Royce JS
ABSTRACT: Objective: To review the diagnosis and management of headaches in older persons. Methods: Review of the literature and illustration of concepts via case presentations. Results: Headache disorders are very common in the elderly. Serious etiologies for new-onset headache abound in this population, which necessitates brain imaging as an initial step in the workup. Primary headache disorders such as migraine change in phenotype with aging. In addition, hypnic headache, a novel primary headache, occurs in patients over 60 years of age. Medical treatment of the older individual must take into account the specific diagnosis as well as the specific characteristics of the older patient. These may include reduced medication tolerance, contraindications to medications due to comorbid conditions, and aggravation of headaches by the medications themselves. Finally, medications that relieve headaches can, with chronic and regular use, cause medication overuse headaches in patients with primary headache disorders. Conclusion: The diagnosis and management of headache disorders in the elderly is challenging. Primary care physicians should become familiar with diagnostic criteria and appropriate management for common causes of headache in elderly persons
Case-Based Review
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