Drugs & Aging

, Volume 1, Issue 1, pp 48–56 | Cite as

Treatment of the Elderly Patient with Headache or Trigeminal Neuralgia

  • Henry J. Kaminski
  • Robert L. Ruff
Drug Therapy

Summary

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.

Keywords

Migraine Cluster Headache Baclofen Trigeminal Neuralgia Giant Cell Arteritis 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bogousslavasky J, Regli F, Van Meile G, Payot M, Uske A. Migraine stroke. Neurology 38: 223–227, 1988CrossRefGoogle Scholar
  2. Camel M, Grubb RL. Treatment of chronic subdural hematoma by twist-drill craniostomy with continuous catheter drainage. Journal of Neurosurgery 65: 183–187, 1986PubMedCrossRefGoogle Scholar
  3. Cook NR, Evans DA, Funkenstein HH, Scherr PA, Ostfeld AM, et al. Correlates of headache in a population-based cohort of elderly. Archives of Neurology 46: 1338–1344, 1989PubMedCrossRefGoogle Scholar
  4. Dalessio JO (Ed.) Wolffs headache and other head pain, 5th ed., Oxford University Press, New York, 1987Google Scholar
  5. Daroff AB, Whitney CM. The treatment of vascular headaches. Headache 26: 470–472, 1986PubMedCrossRefGoogle Scholar
  6. Delecoeuillerie G, Joly P, Cohen De Lara A, Paolaggi JB. Polymyalgia rheumatica and temporal arteritis: a retrospective analysis of prognostic features and different corticosteroid regimens (11 year survey of 210 patients). Journal of Neurology, Neurosurgery and Psychiatry 47: 733–739, 1988Google Scholar
  7. Edmeads J. The cervical spine and headache. Neurology 38: 1874–1878, 1988PubMedCrossRefGoogle Scholar
  8. Fisher CM. Late-life migraine accompaniments: further experience. Stroke 17: 1033–1042, 1986PubMedCrossRefGoogle Scholar
  9. Fromm GH. Trigeminal neuralgia. Neurologic Clinics 7: 305–319, 1989PubMedGoogle Scholar
  10. Gorelick PB, Hier DB, Caplan LR, Langenberg P. Headache in acute cerebrovascular disease. Neurology 36: 1445–1450, 1986PubMedCrossRefGoogle Scholar
  11. Hackett GI, Boddic HG, Harrison P. Chronic muscle contraction headache: the importance of depression and anxiety. Journal of the Royal Society of Medicine 80: 689–691, 1987PubMedGoogle Scholar
  12. Hale WE, May FE, Marks RG, Moore MT, Stewart RB. Headache in the elderly: an evaluation of risk factors. Headache 27: 272–276, 1987PubMedCrossRefGoogle Scholar
  13. Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria of headache disorders, cranial neuralgias and facial pain. Cephalalgia 8 (Suppl.): 1–96, 1988CrossRefGoogle Scholar
  14. Keltner JL. Giant-cell arteritis: signs and symptoms. Ophthalmology 89: 1101–1110, 1982PubMedGoogle Scholar
  15. Kudrow L. Response of cluster headache to oxygen inhalation. Headache 21: 1–4, 1981PubMedCrossRefGoogle Scholar
  16. Luxon LM, Harrison MJG. Chronic subdural hematoma. Quarterly Journal of Medicine 48: 43–53, 1979PubMedGoogle Scholar
  17. Manzoni GC, Farina S, Lanfranchi M, Solari A. Classic migraine: clinical findings in 164 patients. European Neurology 24: 163–169, 1985PubMedCrossRefGoogle Scholar
  18. McRae RP, Liebson PR. Hypertensive crisis. Medical Clinics of North America 70: 749–767, 1986PubMedGoogle Scholar
  19. Mokri B, Sundt TM, Houser OW, Piepgras DG. Spontaneous dissection of the cervical internal carotid artery. Annals of Neurology 19: 126–138, 1986PubMedCrossRefGoogle Scholar
  20. National Institutes of Health Consensus Conference. Differential diagnosis of dementing diseases. Journal of the American Medical Association 258: 3411–3416, 1987CrossRefGoogle Scholar
  21. O’Neill P. Cranio-cerebral trauma. In Tallis R (Ed.) The clinical neurology of old age, pp. 285–296, John Wiley & Sons, Chichester, 1989Google Scholar
  22. Phillipi W, Manon-Espaillat R, Spiegel P, Ruff RL. Clinical and electroencephalographic manifestations of baclofen-induced encephalopathy: review of the literature. Abstract. Neurology 40 (Suppl. 1): 134, 1990Google Scholar
  23. Plum F, Posner JB. The diagnosis of stupor and coma, pp. 230–233, FA Davis, Philadelphia, 1980Google Scholar
  24. Raskin NH. Headache. Churchill Livingstone, New York, 1988Google Scholar
  25. Ratner EJ. Jawbone cavities and trigeminal and atypical facial neuralgias. Oral Surgery and Medical Pathology 48: 3–20, 1979CrossRefGoogle Scholar
  26. Ruff RL, Swanson PD. Treatment of headache and trigeminal neuralgia in the elderly. In Vestal RE (Ed.) Drug treatment in the elderly, pp. 213–220, ADIS Health Science Press, Sydney, 1984Google Scholar
  27. Rushton JG, Rooke ED. Brain tumor headache. Headache 2: 147–152, 1962PubMedCrossRefGoogle Scholar
  28. Salaki JS, Louria DB, Chmel H. Fungal and yeast infections of the central nervous system. Medicine 63: 108–131, 1984PubMedCrossRefGoogle Scholar
  29. Schmidley JW, Hlavin ML, Likavec M, Kaminski HJ. Transient neurologic deficit caused by CT negative subdural hematoma. Abstract. Neurology 40 (Suppl.): 433, 1990Google Scholar
  30. Solomon S, Cappa KG. The headache of temporal arteritis. Journal of the American Geriatric Society 35: 163–165, 1987Google Scholar
  31. Tang RA. Giant cell arteritis diagnosis and management. Seminars in Ophthalmology 3: 244–248, 1988CrossRefGoogle Scholar
  32. Tomsak RL, Jergens PB. Benign recurrent transient monocular blindness: a possible variant of acephalgic migraine. Headache 27: 66–69, 1987PubMedCrossRefGoogle Scholar
  33. Troost BT, Mark LE, Maroon JC. Resolution of classic migraine after removal of an occipital lobe AVM. Annals of Neurology 5: 199–201, 1979PubMedCrossRefGoogle Scholar
  34. Verweij RD, Wijdicks EFM, Van Gijn J. Warning headache in aneurysmal subarachnoid hemorrhage: a case-control study. Archives of Neurology 45: 1019–1020, 1988PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 1991

Authors and Affiliations

  • Henry J. Kaminski
    • 1
  • Robert L. Ruff
    • 1
  1. 1.Department of Neurology, Cleveland Department of Veterans Affairs Medical CenterCase Western Reserve UniversityClevelandUSA

Personalised recommendations