Primary headache syndromes in the elderly: epidemiology, diagnosis
and treatment
Secondary headaches due to e.g. temporal arteritis or a brain tumour are common among the elderly, although primary headache disorders are also common in this 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 randomised 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.
[1] Schwaiger J, Kiechl S, Seppi K, Sawires M, Stockner H, Erlacher T, Mairhofer ML, Niederkofler H, Rungger G, Gasperi A, Poewe W, Willeit J. Prevalence of primary headaches and cranial neuralgias in men and women aged 55-94 years (Bruneck Study). Cephalalgia. 2009; 29: 179-187.
[2] Haan J, Hollander J, Ferrari MD. Migraine in the elderly: a review. Cephalalgia. 2007; 27: 97-106.
[3] Launer LJ, Terwindt GM, Ferrari MD. The prevalence and characteristics of migraine in a population-based cohort-The GEM Study. Neurology. 1999; 53: 537-542.
[4] Pascual J, Berciano J. Experience in the diagnosis of headaches that start in elderly people. J Neurol Neurosurg Psychiatry. 1994; 57: 1255-1257.
[5] Ozge A. Chronic daily headache in the elderly. Curr Pain Headache Rep. 2013; 17:382.
[6] Tonini MC, Bussone G. Headache in the elderly: primary forms. Neurol Sci. 2010; 31 Suppl 1: S67-S71.
[7] Vongvaivanich K, Lertakyamanee P, Silberstein SD, Dodick DW. Late-life migraine accompaniments; a narrative review. Cephalalgia. 2015; 35: 894-911
[8] Schoenen J, Sandor PS. Headache with focal neurological signs or symptoms: a complicated differential diagnosis. Lancet Neurol. 2004; 3: 237-245.
[9] Bigal ME, Rapoport AM, Sheftell FD, Tepper SJ, Lipton RB. Transformed migraine and medication overuse in a tertiary headache centre--clinical characteristics and treatment outcomes. Cephalalgia. 2004; 24: 483-490.
[10] Gori S, Lucchesi C, Morelli N, Maestri M, Bonanni E, Murri L. Sleep-related migraine occurrence increases with aging. Acta Neurol Belg. 2012; 112: 183-187.
[11] Sacco S, Ricci S, Carolei A. Migraine and vascular diseases: a review of the evidence and potential implications for management. Cephalalgia. 2012; 32: 785-795.
[12] Mattsson P, Ekselius L. Migraine, major depression, panic disorder, and personality traits in women aged 40-74 years: a population- based study. Cephalalgia. 2002; 22: 543-551.
[13] Walker RA, Wadman MC. Headache in the elderly. Clin Geriatr Med. 2007; 23: 291-305.
[14] Burris, JE. Pharmacologic approaches to geriatric pain management. Arch Phys Med Rehabil. 2004; 85: S45-S49.
[15] AGS Panel on persistent pain in older persons. The management of persistent pain in older persons. J Am Geriatr Soc. 2002; 50: S205- S224.
[16] Griffin MR, Piper JM, Daugherty JR, Snowden M, Ray WA. Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons. Ann Intern Med. 1991; 114: 257-263.
[17] Robbins MS, Lipton RB. Management of headache in the elderly. Drugs Aging. 2010; 27: 377-398.
[18] Hall GC, Brown MM, Mo J, MacRae KD. Triptans in migraine: the risks of stroke, cardiovascular disease, and death in practice. Neurology. 2004; 62: 563-568.
[19] Hershey LA, Bednarczyk EM. Treatment of headache in the elderly. Curr Treat Options Neurol. 2013; 15: 56-62.
[20] Aurora SK, Dodick DW, Turkel CC, DeGryse RE, Silberstein SD, Lipton RB, Diener HC, Brin MF; PREEMPT 1 Chronic Migraine Study Group. OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 1 trial. Cephalalgia. 2010; 30: 793-803.
[21] Diener HC, Dodick DW, Aurora SK, Turkel CC, DeGryse RE, Lipton RB, Silberstein SD, Brin MF; PREEMPT 2 Chronic Migraine Study Group. OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial. Cephalalgia. 2010; 30: 804-814.
[22] The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013; 33: 629-808.
[23] Schwartz BS, Stewart WF, Simon D, Lipton RB. Epidemiology of tension-type headache. JAMA. 1998; 279: 381-383.
[24] Camarda R, Monastero R. Prevalence of primary headaches in Italian elderly: preliminary data from the Zabut Aging Project. Neurol Sci. 2003; 24 Suppl 2: S122-S124.
[25] Fuh JL, Wang SJ, Lu SR, Tsai PH, Lai TH, Lai KL. A 13-year long-term outcome study of elderly with chronic daily headache. Cephalalgia. 2008; 28: 1017-1022. [26] Loder E, Rizzoli P. Tension-type headache. BMJ. 2008; 336: 88-92.
[27] Bendtsen L, Evers S, Linde M, Mitsikostas DD, Sandrini G, Schoenen J; EFNS. EFNS guideline on the treatment of tension- typeheadache - report of an EFNS task force. Eur J Neurol. 2010; 17: 1318-1325.
[28] Bigal ME, Rapoport AM, Hargreaves R. Advances in the pharma cologic treatment of tension-type headache. Curr Pain Headache Rep. 2008; 12:442-446.
[29] Cerbo R, Barbanti P, Fabbrini G, Pascali MP, Catarci T. Amitri ptyline is effective in chronic but not in episodic tension- type headache: pathogenetic implications. Headache. 1998; 38: 453- 457.
[30] Fumal A, Schoenen J. Tension-type headache: current research andclinical management. Lancet Neurol. 2008; 7: 70-83.
[31] Bettucci D, Testa L, Calzoni S, Mantegazza P, Viana M, Monaco F. Combination of tizanidine and amitriptyline in the prophylaxis of chronic tension-type headache: evaluation of efficacy and impact on quality of life. J Headache Pain. 2006; 7: 34-36.
[32] Bendtsen L, Jensen R. Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache. Neurology. 2004; 62: 1706-1711.
[33] Broner SW, Cohen JM. Epidemiology of cluster headache. Curr Pain Headache Rep. 2009; 13: 141-146.
[34] Kunkel, RS. Headaches in older patients: special problems and concerns. Cleve Clin J Med. 2006; 73: 922-928.
[35] Linn FH, Rinkel GJ, Algra A, van Gijn J. Headache characteristics in subarachnoid heamorrhage and benign thunderclap headache. J Neurol Neurosurg Psychiatry 1998; 65: 791-793
[36] Ruiz, M, Pedraza, MI, de la Cruz, C, Barón J, Muñoz I, Rodríguez C, Celorrio M, Mulero P, Herrero S, Guerrero AL. Headache in the elderly: characteristics in a series of 262 patients. Neurologia. 2014; 29: 321-326.
[37] Liang JF, Wang S J. Hypnic headache: a review of clinical features, therapeutic options and outcomes. Cephalalgia. 2014; 34: 795-805.
[38] Pearce JM. Clinical features of the exploding head syndrome. J Neurol Neurosurg Psychiatry 1989 Jul; 52: 907-910
[39] Frese A, Summ O, Evers S. Exploding head syndrome: six new cases and review of the literature. Cephalalgia 2014 Sep; 34: 823- 827