Headache in the elderly

Kaniecki, Robert G.; Levin, A.

doi:10.1016/b978-0-12-804766-8.00028-5

Cited by 17 publications

(13 citation statements)

References 127 publications

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“…Headache is a common complaint seen in any healthcare setting. When approaching a presentation of such, especially acutely, it is important to rule out red flags such as infections (meningitis, epidural abscesses and osteomyelitis), cerebrovascular accidents, rheumatological causes (giant cell arteritis or polymyalgia rheumatica), primary musculoskeletal degenerative conditions or worse yet malignancies (primary or metastatic) before making a diagnosis of primary headaches (Kaniecki and Levin, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…An elderly lady presented to her geriatrician with chronic headaches, occipital neuralgia and neck pain. Headache is a relatively common presentation and it is key to rule out common secondary causes (infection, cerebrovascular accidents, rheumatological and malignancies) before considering rarer differentials such as CDS (Kaniecki and Levin, 2019). CDS involves the deposition of CPPD crystals around the odontoid process which leads to inflammation within the joint (Bouvet et al, 1985).…”

Section: Introductionmentioning

confidence: 99%

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Calcium Pyrophosphate Dihydrate (CPPD) Crystal Deposition Disease, Crowned Dens Syndrome (CDS) and Its Mimicries: Case Report

Singh¹,

Lee²

2021

FMCR

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Headache is one of the most encountered presentations worldwide. Hence, the approach in which practitioners take in investigating, diagnosing and managing it is crucial given the high complication rates from secondary causes seen more commonly in the elderly population. We discuss a case of a patient with chronic headaches, features of occipital neuralgia and neck pain who was eventually diagnosed with Crowned Dens Syndrome (CDS). We intend to highlight this unique presentation of Calcium Pyrophosphate crystal deposition (CPPD) disease in the spine and the need to consider a broad range of differentials especially in an elderly individual presenting with headaches.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Calcium Pyrophosphate Dihydrate (CPPD) Crystal Deposition Disease, Crowned Dens Syndrome (CDS) and Its Mimicries: Case Report

Singh¹,

Lee²

2021

FMCR

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“…In contrast to primary headache disorders, secondary headache disorders are classified by their structural or otherwise suspected etiology. 27 Additional diagnostic information comes from any neurological examination abnormalities, appropriate neuroimaging modalities, and adjunctive laboratory testing. It is important to note that secondary headache diagnoses are abundant in number with the ICHD-3 providing a list of 8 different categories and 46 subcategories of potential options.…”

Section: History Taking: Secondary Headache Disordersmentioning

confidence: 99%

“…Among older adults, primary headache disorders still account for about two-thirds of headache visits to a provider, despite the fact that older adults are also roughly 12 times more likely to have serious underlying causes than younger patients. 27 For instance, migraine is the second most common primary headache disorder affecting older adults, despite the fact that migraine prevalence and incidence decreases with increasing age. 33,34 In some cases, migraine can have new onset after the age of 65, although TTH and other primary headache disorders, such as hypnic headache, more commonly manifest after age 65 than migraine.…”

Section: Pearlsmentioning

confidence: 99%

Approach to Headache

Bobker

Safdieh

2021

Semin Neurol

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There is a very high prevalence of headache in both outpatient and inpatient settings, in the United States and worldwide, due to an abundance of possible causes. Having a practical and systematic approach to evaluating and treating headache is, therefore, key to making the correct diagnosis, or possibly overlapping diagnoses. Taking a thorough and methodical headache history is the mainstay for diagnosis of both primary and secondary headache disorders. Evaluation and workup should include a complete neurological examination, consideration of neuroimaging in specific limited situations, and serum or spinal fluid analysis if indicated. Adopting a diagnostic approach to headache ensures that cannot-miss, or potentially fatal, headache syndromes are not overlooked, while resource-intensive tests are performed only on an as-needed basis.

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“…The primary HAs include migraine, tension-type headache, trigeminal autonomic cephalalgias, and other primary HA disorders [ 1 ]. Primary HAs comprise two-thirds of all HA diagnoses in the elderly [ 2 ], and every year, primary HAs affect nearly three billion adults [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of ketamine in the treatment of migraines and other unspecified primary headache disorders compared to placebo and other interventions: a systematic review

Chah

Jones

Milord

et al. 2021

J Dent Anesth Pain Med

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Background Migraine headaches are the second leading cause of disability worldwide and are responsible for significant morbidity, reduction in the quality of life, and loss of productivity on a global scale. The purpose of this systematic review and meta-analysis was to evaluate the efficacy of ketamine on migraines and other primary headache disorders compared to placebo and other active interventions, such as midazolam, metoclopramide/diphenhydramine, and prochlorperazine/diphenhydramine. Methods An electronic search of databases published up to February 2021, including Medline via PubMed, EMBASE, Web of Science, and Cochrane Library, a hand search of the bibliographies of the included studies, as well as literature and systematic reviews found through the search was conducted to identify randomized controlled trials (RCTs) investigating ketamine in the treatment of migraine/headache disorders compared to the placebo. The authors assessed the risk of bias according to the Cochrane Handbook guidelines. Results The initial search strategy yielded 398 unduplicated references, which were independently assessed by three review authors. After evaluation, this number was reduced to five RCTs (two unclear risk of bias and three high risk of bias). The total number of patients in all the studies was 193. Due to the high risk of bias, small sample size, heterogeneity of the outcomes reported, and heterogeneity of the comparison groups, the quality of the evidence was very low. One RCT reported that intranasal ketamine was superior to intranasal midazolam in improving the aura attack severity, but not duration, while another reported that intranasal ketamine was not superior to metoclopramide and diphenhydramine in reducing the headache severity. In one trial, subcutaneous ketamine was superior to saline in migraine severity reduction; however, intravenous (I.V.) ketamine was inferior to I.V. prochlorperazine and diphenhydramine in another study. Conclusion Further double-blind controlled studies are needed to assess the efficacy of ketamine in treating acute and chronic refractory migraines and other primary headaches using intranasal and subcutaneous routes. These studies should include a long-term follow-up and different ketamine dosages in diagnosed patients following international standards for diagnosing headache/migraine.

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Headache in the elderly

Cited by 17 publications

References 127 publications

Calcium Pyrophosphate Dihydrate (CPPD) Crystal Deposition Disease, Crowned Dens Syndrome (CDS) and Its Mimicries: Case Report

Calcium Pyrophosphate Dihydrate (CPPD) Crystal Deposition Disease, Crowned Dens Syndrome (CDS) and Its Mimicries: Case Report

Approach to Headache

Efficacy of ketamine in the treatment of migraines and other unspecified primary headache disorders compared to placebo and other interventions: a systematic review

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