This month is Migraine and Headache Awareness month. We want to provide you with some important information related to headaches in the elderly. Most primary headaches in the elderly are similar to those in younger patients which include tension, migraine, and cluster; however, there may be some differences, such as late-life migraine accompaniments and hypnic headaches.

Although migraines in younger people usually present with headache, migraines in older persons may initially appear with migraine accompaniments which can include visual or sensory phenomena 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 cerebella 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. They also may have hypnic headaches that awaken them from sleep, are short-lived, and occur only in the elderly.

However, a change in a chronic headache pattern or a new onset of headaches in an elderly individual could raise some suspicions. It can be considered a secondary headache associated with sometimes very serious medical conditions. The probability of secondary headache increases steadily with age. Temporal arteritis occurs almost exclusively in the elderly population. Because of its grave prognosis and ease of treatment, this condition should always be considered a possibility in the elderly patient with headache. A throbbing non-migranous headache may indicate an impending cerebrovascular event. Other causes of headache, such as mass lesions (tumors, subdural hematomas), drugs (nitrates, estrogens) and depression, take on greater significance in the elderly. While migraine and cluster headaches are more common in young adults, they may begin in older persons; indeed, transient migraine accompaniments are “TIA mimics”.

Certain rescue treatments for migraine headache in younger individuals should not be used in elderly patients because of the risk of coronary artery disease. Some effective prophylactic agents for migraine in younger patients are not usually recommended for older individuals because of the risks of cognitive impairment, urinary retention, and cardiac arrhythmia.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3553408/