Headache Disorders in the Elderly

Headache prevalence declines in the elderly, but remains a common reason for patients to seek medical attention. Although primary headache types remain most frequent, secondary headaches become more likely in this age group. Accurate diagnosis is essential, and the clinician should maintain a lower threshold for ordering laboratory testing and neuroimaging. The elderly are more likely to have co-existent medical conditions, which present both therapeutic limitations and opportunities when selecting acute and preventative treatments for headache. Altered pharmacokinetics and pharmacodynamics in this age group may increase the likelihood of side effects and drug interactions. Downward dose adjustments and simplifying medication regimens are often appropriate, as is using nonpharmacologic therapies whenever possible. Due to frequent contraindications related to acute medications, preventative drug regimens and nonpharmacologic treatments assume greater prominence when treating the elderly suffering frequent/severe headaches. Medication-induced headache and analgesic rebound headache occur commonly in this age group and may initiate, aggravate, or perpetuate headache. Chronic daily headache is often due to these conditions, and recognition of these problems can allow effective intervention.