Headaches in the elderly

There is a non-controversial definition about who is an elderly patient. The age group above 85 years is the fastest growing segment in the total population. Persisting pain is not rare in this patient group and the prevalence for persisting pain is 40–79%. Migraine prevalence declines gradually after the age of 40 years, but even in the age group of 60 years and older up to 5% complain of migraine and in some patients the symptoms change towards more tension type-like headaches. Tension-type headaches are thought to be the most prevalent primary headaches in the elderly, with a 1-year prevalence of about 36%; secondary headaches often present as tension type-like headaches. A typical age-bounded headache is hypnic headache, which is only seen in patients older than 55 years of age. In the treatment of headaches in the elderly, the pharmacokinetic changes with age should be considered; the distribution volume and elimination kinetics are different in the elderly. Therefore, treatment should be initiated as ‘slow and low’.