Interventional Headache Management in The Elderly

Part of the Headache book series (HEAD)


Headache is one of the most prevalent complaints in neurology. It is also prevalent in the elderly population, although the relative frequency shows some decline. The evaluation and management of headache differ in many aspects in the elderly population, mostly regarding the etiology of headache, phenotypes for primary headache disorders, and comorbid medical conditions. The prevalence of secondary headache disorders increases dramatically in the elderly, and these secondary causes should be excluded first. Comorbid systemic diseases and multiple drug interactions are common limiting factors for pharmacotherapy in this population group. Interventional procedures could take the place of drugs in the elderly because of additional advantages. Peripheral nerve blocks and botulinum toxin injections are the main interventional methods for headache disorders and can provide relief in pain with less concern regarding drug-adverse effects.

In this chapter, we will discuss the available interventional methods for the treatment of headache in the elderly.


Headache Elderly Management Interventional methods Botulinum toxin Peripheral nerve blocks 


  1. 1.
    Prencipe M, Casini AR, Ferretti C, Santini M, Pezzella F, Scaldaferri N, et al. Prevalence of headache in an elderly population: attack frequency, disability, and use of medication. J Neurol Neurosurg Psychiatry. 2001;70(3):377–81.CrossRefGoogle Scholar
  2. 2.
    Özge A. Chronic daily headache in the elderly. Curr Pain Headache Rep. 2013;17(12):382.CrossRefGoogle Scholar
  3. 3.
    Schwaiger J, Kiechl S, Seppi K, Sawires M, Stockner H, Erlacher T, et al. Prevalence of primary headaches and cranial neuralgias in men and women aged 55–94 years (Bruneck Study). Cephalalgia. 2009;29(2):179–87.CrossRefGoogle Scholar
  4. 4.
    Manzoni GC, Maffezzoni M, Lambru G, Lana S, Latte L, Torelli P. Late-onset cluster headache: some considerations about 73 cases. Neurol Sci. 2012;33 Suppl 1:S157–9. Scholar
  5. 5.
    Hershey LA, Bednarczyk EM. Treatment of headache in the elderly. Curr Treat Options Neurol. 2013;15(1):56–62.CrossRefGoogle Scholar
  6. 6.
    Hascalovici JR, Robbins MS. Peripheral nerve blocks for the treatment of headache in older adults: a retrospective study. Headache. 2017;57(1):80–6.CrossRefGoogle Scholar
  7. 7.
    Bigal ME, Liberman JN, Lipton RB. Age-dependent prevalence and clinical features of migraine. Neurology. 2006;67(2):246–51.CrossRefGoogle Scholar
  8. 8.
    Aurora S, Winner P, Freeman M, Spierings EL, Heiring J, DeGryseet RE, et al. Botulinum neurotoxin type A for treatment of chronic migraine: pooled analyses of the PREEMPT clinical program 32-week open-label phase. Cephalalgia. 2009;29(Suppl 1):7–8.Google Scholar
  9. 9.
    Ahmed F, Zafar HW, Buture A, Khalil M. Does analgesic overuse matter? Response to OnabotulinumtoxinA in patients with chronic migraine with or without medication overuse. Springerplus. 2015;4:589.CrossRefGoogle Scholar
  10. 10.
    Wrobel Goldberg S, Silberstein S, Grosberg BM. Considerations in the treatment of tension-type headache in the elderly. Drugs Aging. 2014;31(11):797–804.CrossRefGoogle Scholar
  11. 11.
    Karadaş O, Ipekdal IH, Ulaş UH, Kütükçü Y, Odabaşi Z. Botulinumneuro-toxin aype-A in the treatment of chronic tension type headache associated with pericranial tenderness. Agri. 2012;24(1):9–14.CrossRefGoogle Scholar
  12. 12.
    Levin M. Resident and fellow section. Teaching case: dialysis headache. Headache. 2013;53:181–2.CrossRefGoogle Scholar
  13. 13.
    Robbins MS, Lipton RB. Management of headache in the elderly. Drugs Aging. 2010;27(5):377–98.CrossRefGoogle Scholar
  14. 14.
    Blumenfeld A, Ashkenazi A, Napchan U, Bender SD, Klein BC, Berliner R, et al. Expert consensus recommendations for the performance of peripheral nerve blocks for headaches-a narrative review. Headache. 2013;53(3):437–46.CrossRefGoogle Scholar
  15. 15.
    Ruiz Piñero M, Mulero Carrillo P, PedrazaHueso MI, de la Cruz Rodríguez C, LópezMesonero L, Guerrero Peral AL. Pericranial nerve blockade as a preventive treatment for migraine: experience in 60 patients. Neurologia. 2016;31(7):445–51.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Health Sciences University, Istanbul Training and Education Hospital, Department of NeurologyIstanbulTurkey
  2. 2.Department of NeurologySchool of Medicine, Süleyman Demirel UniversityIspartaTurkey

Personalised recommendations