Primary headache syndromes in the elderly:epidemiology,diagnosis and treatment  

作　　者：Willebrordus P.J.van Oosterhout Carlo Cheung Joost Haan 

机构地区：[1]Department of Neurology,Leiden University Medical Center,Leiden,the Netherlands [2]Department of Neurology,Medical Center Haaglanden,the Hague,the Netherlands [3]Department of Neurology,Alrijne Hospital,Leiderdorp,the Netherlands

出　　处：《Journal of Clinical & Translational Research》2016年第2期1-7,共7页临床和转化研究

摘　　要：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. Althoughtreatments for the most common primary headaches are available, many limitations hamper their use in thisgroup. 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 headachein the elderly and their treatments, with emphasis on age-specific problems.Relevance for patients: Primary headache syndromes in older patients ask for specific treatment considerationsdue to comorbidity, polypharmacy and an increased risk of side effects. Clinically, the headaches canbe different and atypical. Results from clinical trials cannot be generalized to the elderly because thesegroups 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 mostcommon headache presentation in elderly, also includes a relatively large proportion of patients with asecondary headache warranting further testing. Trigeminal autonomous cephalalgias are rare, and canpresent with pseudo dementia. Medication overuse and medication-induced headaches are relatively common,for which patient education, ceasing drugs and withdrawal from caffeine containing substances arepivotal. Furthermore, hypnic headache, exploding head syndrome and benign thunderclap headache arespecific for this patient group and require specific treatment.

关 键 词：cluster HEADACHE elderly MIGRAINE primary HEADACHES tension-type HEADACHE 

分 类 号：R73[医药卫生—肿瘤]