Headaches in older patients: Ddx and Tx of vascular and inflammatory pain

Caution must be used in the elderly in making the diagnosis of complicated migraine, since transient ischemic attacks (TIAs), other cerebrovascular dysfunction, or structural lesions also can produce prolonged neurologic deficits with headache. Although hypertensive headache itself has no specific diagnostic features, patients who do complain of headache with episodes of hypertension usually localize the pain to the occipital region. This headache is most pronounced on awakening in the morning, usually diminishing 2 to 3 hours after arising.