Geriatric Headaches and Migraines

Older people have fewer headaches than younger ones, and women have more headaches than men through their lives. For example, between ages 21 and 34, the prevalence of headaches is 92% in women and 74% in men; after age 75, the prevalence drops to 55% and 21%, respectively.

Migraines tend to disappear with age, too. At age 70, only 10% of women and 5% of men experience them. 

But some headaches in older age can indicate a much more serious medical condition.

Late-Life Migraine Accompaniments

Late-life migraine accompaniments are defined as passing neurological symptoms that can affect vision, speech, movement, and behavior. They are similar or identical to migraine "aura," the symptoms the precede a migraine. However, headache is associated with only 50% of cases and may be mild. 

Migraine accompaniments may consist of visual symptoms such as transient blindness, homonymous hemianopsia (loss of vision on one side of one’s visual field), and blurring of vision; paresthesias (numbness, tingling, pins-and-needles sensation), a heavy feeling in an extremity like an arm or leg; brain stem and cerebellar dysfunction such as ataxia (clumsiness), hearing loss, tinnitus (ringing in ears), vertigo (sense of room spinning), syncope (loss of consciousness); and disturbances of speech, such as dysarthria (slurred speech) or aphasia (loss of ability to speak). They may come in succession.

These symptoms can also be seen in strokes, transient ischemic attacks (TIAs), or some types of seizures, so the doctor will run tests to be sure of the cause.

If the episodes are frequent, preventive treatment can be considered with medications such as divalproex sodium (Depakote, Depakene), topiramate (Qudexy XR, Topamax, Trokendi XR), metoprolol (Lopresor, Toprol XL), or propranolol (Inderal LA, InnoPran XL). Your doctor will talk to you about best options for treating acute symptoms.

Cerebrovascular Disease

Headaches commonly accompany stroke. In a study of 163 patients who’d had a stroke, 60% reported a headache with the stroke, especially women and those with a history of headaches. Up to 46% reported having an incapacitating headache; most said the headache was mild to moderately painful. The headaches are equally likely to come on quickly or slowly.

 

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Head Trauma

Although there are many causes of head trauma, falling is a particular problem. Approximately 30% of people ages 65 and older fall at least once a year. If the person has dementia, he might not remember having fallen.

Subdural hematomas, or bleeding on the brain, can result from a mild head injury. These brain traumas can be life-threatening or go away on their own.

 

Headaches are present in up to 90% of patients with head trauma, including subdural hematomas. The headaches can range from mild to severe, can be intermittent or constant, and can happen on one or both sides of the head. Coughing, straining, or exercise can make them worse, and sometimes there's vomiting and nausea.

 

Temporal Arteritis

Headaches are the most common symptom of temporal (giant cell) arteritis, or TA, a disease that causes your  arteries -- blood vessels that carry oxygen from your heart to the rest of your body -- to swell and narrow. It usually happens to the large and medium-sized temporal arteries that run along both sides of your head. The cells of these inflamed arteries look huge under a microscope; hence, the condition’s name. 

TA is more common in people older than age 50. The headache pain is described most often as throbbing, and may be intermittent or constant. The headache can be on one or both sides of the head, typically near the temples. But it can be over the forehead or even the back of the head. About half of the people with TA also get bad pain in the jaw with chewing.

Trigeminal Neuralgia

When there is pressure on the trigeminal nerve, which controls facial feeling, it can cause excruciating pain in the lower part of the face, around the nose, and above the eye. The neuralgia, or nerve pain, can be triggered by doing ordinary things – brushing your teeth, chewing, or blowing your nose. In a small number of cases, the pain is caused by a tumor pressing on the trigeminal nerve.

The condition is more common in people older than age 50 and is seen more in women than men. It may run in families. Risk factors including hypertension and multiple sclerosis.

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Medications that may help ease symptoms of trigeminal neuralgia, alone or sometimes in combination, are anticonvulsants or seizure medicines that include carbamazepine (Carbatrol, Epitol, Equetro, Tegretol); oxcarbazepine (Oxtellar XR and Trileptal); baclofen and phenytoin (Dilantin, Phenytek); clonazepam (Klonopin); divalproex sodium (Depakote, Depakene); topiramate (Quedexy TR, Topamax, Trokendi XR); lamotrigine (Lamicatal); gabapentin (Horizant, Neurontin); and pimozide (Orap).

About 30% of people don’t respond to medication but may respond to surgery.  Brain surgery can help move the trigeminal nerve from a nearby blood vessel and correct the problem. Another technique damages the nerve to prevent it from causing facial pain.

 

 

Postherpetic Neuralgia

Postherpetic neurlagia is nerve pain that lingers after an outbreak of shingles, a rash also known as herpes zoster that may also affect the face. Shingles has the same origin as chickenpox, caused as it is by the varicella virus. It is characterized by sores that form and crust over 3 to 4 weeks. It can cause nerve damage that leads to burning, shooting and tingling pain for 3 months or longer (called postherpetic neuralgia).

The persistence of pain from shingles is more common among people older than age 80. Shingles that involves the face nearly doubles the risk of developing facial posterherpetic neuralgia.

Treatment includes anticonvulsants, antidepressants, aspirin, NSAIDs, and creams.

 

 

Hypnic Headache

Hypnic headache is a rare disorder that occurs in men and women ages 40 to 79. The headache occurs only during sleep and awakens a person at a consistent time. The headache can be on one or both sides of the head, can throb or not, and can range from mild to severe. They typically last for 2-3 hours (but can last up to 6 hours), and they can happen nightly for years.

Treatment might include caffeine pills before bed or a one or two cups of coffee, lithium carbonate, indomethacinatenololmelatonincyclobenzaprine, or prednisone.

To make a diagnosis of hypnic headaches, the doctor will rule out drug withdrawal, temporal arteritis, sleep apnea, brain trauma, migraines, and other causes.

 

 

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on June 12, 2018

Sources

SOURCES:

American Heart Association: "Silent Ischemia and Ischemic Heart Disease."

Serratrice, G. Headache, March 1985.

Vongvaivanich K ., Cephalalgia, September 2015.

Fisher, CM, Canadian journal of neurological sciences, March 1980. 

WebMD: "Temporal Arteritis" sand "How to Treat Nerve Pain After Shingles."

UpToDate: "Clinical manifestations of giant cell arteritis" and "Hypnic headache."

American Association of Neurological Surgeons: "Trigeminal Neuralgia."

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