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Management of Headache in the Elderly

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Abstract

The diagnosis and management of headache disorders in the elderly are challenging. The evaluation of the elderly patient with new-onset or recurrent headache requires a grasp of the heterogeneous set of causes of secondary head pain disorders. Once such aetiologies are excluded, the correct primary headache disorder must be diagnosed. Although tension-type headache is the leading cause of new-onset headache in the elderly, other primary headache disorders such as migraine can manifest in later life, and one disorder, hypnic headache, occurs almost exclusively in the elderly. Primary chronic daily headache persists in elderly patients to a greater extent than the primary episodic headache disorders do. The treatment of elderly patients with primary headache disorders is multifaceted, including acute, prophylactic and at times transitional treatments. Knowledge of drug interactions is particularly important as polypharmacy is the rule. Concomitant illnesses may require adjustments in choice or dose of drugs. In addition, as many acute and preventive treatments are either contra-indicated or poorly tolerated in the elderly, modifiable risk factors for headache progression and perpetuation must be addressed. In spite of these treatment complexities, there are numerous opportunities to bring relief to older patients with primary headache disorders from the currently available therapies. New treatment options for elderly patients with headache will soon be available, including acute, prophylactic and interventional techniques.

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Acknowledgements

No sources of funding were used to assist in the preparation of this review. Dr Robbins has no conflicts of interest that are directly relevant to the content of this review. Dr Lipton has received personal compensation for activities with Advanced Bionics, Allergan, AstraZeneca, Boehringer-Ingelheim, Bristol-Myers Squibb, Cierra, Endo, GlaxoSmithKline, Minster Research, Ltd, Merck, Neuralieve, Novartis, Kowa, Pfizer and Ortho-McNeil as a consultant. He holds stock or stock options in Minster and Neuralieve. He has received research support from Allergan, Ortho-McNeil, Minster, Endo, GlaxoSmithKline, Merck, Neuralieve and ProEthics.

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  1. The Montefiore Headache Center, Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1575 Blondell Avenue, Suite 225, Bronx, New York, 10461, USA

    Matthew S. Robbins & Richard B. Lipton

  2. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA

    Richard B. Lipton

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  1. Matthew S. Robbins
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Correspondence to Matthew S. Robbins.

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Robbins, M.S., Lipton, R.B. Management of Headache in the Elderly. Drugs Aging 27, 377–398 (2010). https://doi.org/10.2165/11315980-000000000-00000

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