Headaches in the elderly

Question 1

Causes

Answer 1

1. Cervical dysfunction
2. Cerebral tumour
3. Temporal arteritis
4. Neuralgias
5. Paget disease
6. Glaucoma
7. Cervical spondylosis
8. Subdural haemorrhage

Question 2

Pitfalls

Answer 2

Recent onset of headache in the elderly has to be treated with caution because it could herald a serious problem, such as;

1. Space-occupying lesion (e.g. neoplasm, subdural haematoma),
2. TA
3. Trigeminal neuralgia
4. Vertebrobasilar insufficiency.

Cervical spondylosis is age-related and may be an important factor in the aging patient

Question 3

Migraine v TIA

Answer 3

Late-life migraine can be mistaken for cerebrovascular disease, especially in the presence of preceding neurological symptoms.

It is the sequence of the visual and sensory symptoms with the spread from face to tongue to hand over some minutes, with clearing in one area as it appears that helps distinguish migraine from TIAs.

Although some patients experience headache with TIAs it is not a distinguishing feature.

Vomiting is suggestive of migraine rather than cerebrovascular disease