The elderly as a whole suffer fewer
headaches than the young. For the majority
headache will represent a minor annoyance to be endured or treated with any available
drug in the
medicine chest. For some,
migraine headaches or
tension-type headaches become entwined with every daily activity. With the advent of modern pharmacology,
headache can often be treated successfully.
Trigeminal neuralgia is a source of particularly high morbidity among the elderly, but may be treated very satisfactorily with
carbamazepine or
baclofen.
Paroxysmal hemicrania is exquisitely sensitive to
indomethacin, while
cluster headache patients receive relief from
oxygen inhalation,
corticosteroids or
lithium.
Headache may be the signature of the disease which leads to serious morbidity and mortality. The 'sentinel'
headache of subarachnoid haemorrhage is evaluated by a physician in 15% of patients who will eventually
rupture an
intracranial aneurysm. Morning
headache with
nausea and
vomiting may represent increased intracranial pressure caused by a tumour, haematoma or
abscess. The elderly patient with a new
headache needs emergency evaluation for
temporal arteritis and rapid
corticosteroid treatment if the diagnosis is confirmed, to prevent
blindness. The broad spectrum of
headache, at times a benign aggravation, while at others the harbinger of death, makes the careful evaluation of each
headache imperative. This article attempts to make the difficult evaluation of
head pain a little easier.