Friday, December 21, 2007

Summarized by Robert W. Griffith, MD
July 16, 1999 (Reviewed: January 21, 2005)

There's one good thing about getting older - you don't get headaches so often. However, although they are less frequent, they can still be extremely annoying, and can sometimes be a sign of some underlying, more serious, condition. In 1997 an article was published on the special features of headaches in older persons.

Most headaches in both young and old persons are caused by non-serious changes in the blood flow over the surface of the brain. These types of headache include migraines, tension headaches and "cluster" headaches. They account for 9 out of 10 headaches in younger people, but only about two-thirds of those in the elderly. It is the remaining one third of headaches that are important, as they may signify a medical condition that requires treatment, or a change in existing treatment.

To make matters more complicated, the symptoms of migraine can change with age in some patients. Indeed, very occasionally migraine occurs for the first time after the age of 50. If you are a migraine sufferer whose symptom-pattern has changed, or if your first migraine occurred after the age of 50, your physician should do further tests to make sure there is no underlying disease. Medication for migraine should be specially tailored for older patients as well - anti-migraine drugs may worsen some medical conditions, while some drugs for other conditions can make a migraine worse.

Diseases that can cause headache in older people include:

* giant cell arthritis (or temporal arthritis) -- a very rare inflammation of the head arteries which can be treated successfully with steroid drugs
* brain tumors (either originating in the brain, or spread from a tumor somewhere else in the body)
* blood clot accumulation (a subdural hematoma, which results from bleeding caused by injury)
* changes in the blood flow to the brain due to arterial disease of the brain arteries
* arthritis of the spine in the neck
* chronic obstructive pulmonary disease (COPD, a troublesome breathing condition caused by chronic bronchitis, emphysema, prolonged heavy smoking)

In badly ventilated homes, especially if the heating arrangements are poor, there is a risk of buildup of carbon monoxide. This can cause dull, diffuse (all over the head) morning headaches, which get better when the person goes outside or opens the windows.

Quite a few medications can cause headaches, which are usually dull, diffuse, and sometimes throbbing. The drugs responsible are either for lowering blood pressure, treating irregular heart beats, treating Parkinson's disease, sedatives, stimulants, pain killers, anti-ulcer drugs or anti-asthma drugs. Your physician may be able to help, by changing the medication, or the dose.

There is a rare condition called hypnic headache, which has been reported in people over 65. The patient is woken up once or twice a night, almost every night, with a headache that lasts half-an-hour or more. The headache usually involves both sides of the head, and causes some nausea. These headaches can be treated with lithium or indomethacin, with a good chance of success.

To summarize, headaches in older persons are more likely to be caused by an underlying disease than is the case in younger people. This means that, if you as an older adult are troubled with headaches, you should visit your physician and ensure that he/she considers the possibility that you may have another, more serious problem, before prescribing "2 aspirins".

* Headaches in older people. How are they different in this age-group? J. Edmeads, Postgrad Med, 1997, vol. 101, pp. 91--100