Advertisement

Treatment of the Older Adult Patient (>50 Years Old) with Acute Headache in the ED

Chapter
  • 555 Downloads

Key Chapter Points

Primary headaches are more common in younger than older adult patients. Adults >50 years old presenting to the ED with headache will require a more detailed evaluation for secondary headache than younger adults. Common secondary headaches in adults >50 years old may include a wide range of disorders, including vascular conditions, acute angle-closure glaucoma, medication side effects, carbon monoxide poisoning, primary and metastatic neoplasm, infection, and trauma. Giant cell arteritis is a medical emergency requiring definitive, presumptive treatment initiation in the ED.

Keywords

Cognitive loss Giant cell arteritis Hypnic headache Subdural hematoma 

References

  1. 1.
    Goldstein JN, Camargo CA, Pelletier AJ, Edlow JA. Headache in the United States emergency departments: demographics, work-up and frequency of pathological disease. Cephalalgia. 2006;26:684–90.PubMedCrossRefGoogle Scholar
  2. 2.
    Kawahata N. Cerebrovascular disease in the elderly – clinical study of 31 cases with acute intracerebral hemorrhages. Rinsho Shinkeigaku. 1990;30:713–17.PubMedGoogle Scholar
  3. 3.
    Fink HA, MacDonald R, Rutks IR, Nelson DB, Wilt TJ. Sildenafil for male erectile dysfunction: a systematic review and meta-analysis. Arch Intern Med. 2002;162:1349–60.PubMedCrossRefGoogle Scholar
  4. 4.
    Müller A, Smith L, Parker M, Mulhall JP. Analysis of the efficacy and safety of sildenafil citrate in the geriatric population. BJU Int. 2007;100:117–21.PubMedCrossRefGoogle Scholar
  5. 5.
    Walker RA, Wadman MC. Headache in the elderly. Clin Geriatr Med. 2007;23:291–305.PubMedCrossRefGoogle Scholar
  6. 6.
    Carpenter CR, Despain B, Keeling TN, Shah M, Rothenberger M. The Six-Item Screener and AD8 for the detection of cognitive impairment in geriatric emergency department patients. Ann Emerg Med. 2011;57:653–61.Google Scholar
  7. 7.
    Galvin JE, Roe CM, Powlishta KK, et al. The AD8: a brief interview to detect dementia. Neurology. 2005;65:559–64.PubMedCrossRefGoogle Scholar
  8. 8.
    Galvin JE, Roe CM, Coats MA, Morris JC. Patient’s rating of cognitive ability: using the AD8, a brief informant interview, as a self-rating tool to detect dementia. Arch Neurol. 2007;64:725–30.PubMedCrossRefGoogle Scholar
  9. 9.
    Komatsu Y, Uemura K, Yasuda S, et al. Acute subdural hemorrhage of arterial origin: report of three cases. No Shinkei Geka. 1997;25:841–45.PubMedGoogle Scholar
  10. 10.
    Petridid AK, Dörner L, Doukas A, et al. Acute subdural hematoma in the elderly; clinical and CT factors influencing the surgical treatment decision. Cen Eur Neurosurg. 2009;70:73–8.CrossRefGoogle Scholar
  11. 11.
    Karnath B. Subdural hematoma: presentation and management in older adults. Geriatrics. 2004;59:18–23.PubMedGoogle Scholar
  12. 12.
    Salvarani C, Cantini F, Boiardi L, Hunder GG. Medical progress: polymyalgia rheumatica and temporal arteritis. NEJM. 2002;347:261–71.PubMedCrossRefGoogle Scholar
  13. 13.
    Salvarini C, Cimino L, Macchioni P, et al. Risk factors for visual loss in an Italian population-based cohort of patients with giant cell arteritis. Arthritis Care Res. 2005;53:293–7.CrossRefGoogle Scholar
  14. 14.
    Gonzalez-Gay MA, Blanco R, Rodriguez-Valverde V, et al. Permanent visual loss and cerebrovascular accidents in giant cell arteritis. Arthritis Rheum. 1998;41:1497–504.PubMedCrossRefGoogle Scholar
  15. 15.
    Pipitone N, Salvarani C. Improving therapeutic options for patients with giant cell arteritis. Curr Opin Rheumatol. 2008;20:17–22.PubMedCrossRefGoogle Scholar
  16. 16.
    Proven A, Gabriel SE, Orces C, O’Fallon M, Hunder GG. Glucocorticoid therapy in giant cell arteritis: duration and adverse outcomes. Arthritis Care Res. 2003;49:703–8.CrossRefGoogle Scholar
  17. 17.
    De Simone R, Marano E, Ranieri A, Bonavita V. Hypnic headache: an update. Neurol Sci. 2006;27:S144–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Evers S, Goadsby PJ. Hypnic headache. Clinical features, pathophysiology, and treatment. Neurology. 2003;60:905–9.PubMedGoogle Scholar
  19. 19.
    Mullally WJ, Hall KE. Hypnic headache secondary to haemangioblastoma of the cerebellum. Cephalalgia. 2010;30:887–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Peatfield RC, Mendoza ND. Posterior fossa meningioma presenting as hypnic headache. Headache. 2003;43:1007–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Gil-Gouveia R, Goadsby PJ. Secondary ‘hypnic headache’. J Neurol. 2007;254:646–54.PubMedCrossRefGoogle Scholar
  22. 22.
    Valentinis L, Tuniz F, Mucchiut M, et al. Hypnic headache secondary to growth hormone-secreting pituitary tumour. Cephalalgia. 2009;29:82–4.PubMedCrossRefGoogle Scholar
  23. 23.
    Garza I, Hall K. Symptomatic hypnic headache secondary to nonfunctioning pituitary macroadenoma. Headache. 2009;49:470–2.PubMedCrossRefGoogle Scholar
  24. 24.
    Lisotto C, Rossi P, Tassorelli C, Ferrante E, Nappi G. Focus on therapy of hypnic headache. J Headache Pain. 2010;11:349–54.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of AnesthesiologyUniversity of PittsburghPittsburghUSA
  2. 2.Dean Health SystemsMadisonUSA

Personalised recommendations