Diagnosis and Treatment of Primary Headache Disorders in Older Adults

Abstract

Objectives To provide a unique perspective on geriatric headache and a number of novel treatment options that are not well known outside of the headache literature. Design Review of the most current and relevant headache literature for practitioners specializing in geriatric care. Results Evaluation and management of headache disorders in older adults requires an understanding of the underlying pathophysiology and how it relates to age‐related physiological changes. To treat headache disorders in general, the appropriate diagnosis must first be established, and treatment of headaches in elderly adults poses unique challenges, including potential polypharmacy, medical comorbidities, and physiological changes associated with aging. Conclusion The purpose of this review is to provide a guide to and perspective on the challenges inherent in treating headaches in older adults. J Am Geriatr Soc 66:2408–2416, 2018.

Health Behaviors and Social Determinants of Migraine in a Canadian Population‐Based Sample of Adults Aged 45‐85 Years: Findings From the CLSA

“…Outside of the realm of physiological changes, it has been suggested that psychological and sociocognitive factors may also account for the relationship between aerobic fitness and migraine. 18 In a longitudinal study using data collected from the Nord-Trøndelag Health Surveys (HUNT study), light exercise 1-3 hours per week and hard physical activity for 1-2 hours per week were associated with reduced risk of migraine. Exercise is also linked to improvements in anxiety and depression among non-clinical samples.…”

“…63 Non-pharmacological treatment options such as lifestyle changes should be considered when caring for the older migraine patient. 18 In a longitudinal study using data collected from the Nord-Trøndelag Health Surveys (HUNT study), light exercise 1-3 hours per week and hard physical activity for 1-2 hours per week were associated with reduced risk of migraine. 19 These findings are comparable to our light and strenuous activity results for women; however, it should be noted that while the HUNT study had large proportions of respondents with and without headache who were 50 years of age or older (30.2% and 52.4%, respectively), the HUNT study had a much lower age bound (20 years) than the present study (45 years).…”

“…7 For example, some less-studied minority groups in the migraine literature include lesbians, gay, and bisexual (LGB) people and Canadian work has shown multiple health inequalities among LGB older adults. 18 Non-pharmacological treatment of migraine is a rapidly expanding field, with special attention being given to a variety of lifestyle factors which may ameliorate risk, including exercise. Understanding the role of social determinants of migraine in aging samples is needed in order to better characterize risk and disease course among those with co-morbid medical conditions and multiple medications, which may affect treatment.…”

“…17 Among older migraineurs, medication options are reduced and non-pharmacological options may be of particular interest to prescribing health care practitioners and patients alike. 18 Non-pharmacological treatment of migraine is a rapidly expanding field, with special attention being given to a variety of lifestyle factors which may ameliorate risk, including exercise. 19 Traditional recommendations for the treatment of chronic pain have excluded physical activity, however, a recent overview of Cochrane Reviews 20 demonstrated that while the quality of the evidence for physical activity/exercise as an intervention is low, there were positive effects and further study with increased methodological rigour is needed.…”

Dipyrone, isometheptene and caffeine association in mild to moderate primary headache: a randomized comparative double-blind study with paracetamol and placebo / Uso da associação de dipirona, isometepteno e cafeína na cefaleia primária leve a moderada: estudo randomizado, cruzado e duplo-cego comparativo com paracetamol e placebo

“…Headache constitutes one of the main presentation of nervous system primary and secondary disorders (1) . If these conditions are not associated with a clear cause, as a pathology, trauma, or systemic disease, they are named primary headache disorders (2) , which constitute the majority of headache cases (1) . According to the International Classification of Headache Disorders, primary headache disorders can be classified as migraine, tension-type headache (TTH), trigeminal autonomic cephalalgias (as cluster headache, depending on the edition) and other primary headache disorders (3)(4) .…”