Purpose of Review

Primary headaches are less common and differ in presentation in older versus younger individuals. Secondary headaches become more common among older patients.

Recent Findings

Diagnosis and management of headaches in those > 65 years are discussed. Migraine and tension-type headaches are rarely new onset in this age group and should be a diagnosis of exclusion. In older individuals, migraine is more likely to be bilateral with less sensory sensitivities. Migraine aura may present without headache; careful assessment is needed to exclude stroke. Other primary headaches discussed include cough, hypnic, and other headaches. Secondary causes discussed include giant cell arteritis, trigeminal post-herpetic neuropathy, sleep apnea, cardiac cephalgia, cervicogenic pain, vascular etiologies, medications, and burning-mouth syndrome.

Summary

In older individuals, primary headaches are diagnoses of exclusion, and treatment is affected by comorbidities and polypharmacy. Secondary headaches are a major consideration requiring appropriate workup. Many treatments can safely be offered regardless of age.

中文翻译：

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老年人口中的头痛：原因，诊断和治疗。

审查目的

原发性头痛较不常见，在老年人和年轻人中表现不同。继发性头痛在老年患者中变得更加普遍。

最近的发现

讨论了那些> 65岁的头痛的诊断和治疗方法。偏头痛和紧张型头痛在这个年龄段很少是新发的，应该诊断为排斥。在老年人中，偏头痛更可能是双侧的，感觉敏感性较低。偏头痛先兆可出现而无头痛；需要仔细评估以排除中风。讨论的其他主要头痛包括咳嗽，精神错乱和其他头痛。讨论的次要原因包括巨细胞动脉炎，三叉神经带状疱疹后神经病，睡眠呼吸暂停，心源性头痛，宫颈源性疼痛，血管病因，药物和烧口综合征。

概要

在老年患者中，原发性头痛被诊断为排斥反应，治疗受到合并症和多药治疗的影响。继发性头痛是需要适当检查的主要考虑因素。无论年龄大小，都可以安全地提供许多治疗方法。