Headache

This chapter presents a case study of 70-year-old woman who presented with 5 days of a headache that she reported as diffuse, pressure-like, and 10 out of 10 in intensity. It describes features of the primary and secondary headaches that are most common in older adults. The chapter discusses the tension-type headache, migraine headache, trigeminal neuralgia, hypnic headache, giant cell arteritis, cervical artery dissection, subarachnoid hemorrhage, traumatic headache and cervicogenic headache. Serum testing for cryptococcal antigen and Lyme disease can help exclude these disease processes too, though positive serum tests will require confirmatory spinal fluid analysis. Spinal fluid analysis should be considered in older adults when a headache etiology remains unclear. Triptans and dihydroergotamine, which are two frequently used evidence-based classes of parenteral primary headache disorder medications, are associated with increased risk of cardiovascular events in patients with cardiovascular risk factors, including advanced age.