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Geriatric headache
Published in Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby, Headache in Clinical Practice, 2018
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby
Age is an important factor in the diagnosis and treatment of headache disorders. Headache prevalence varies with age.1 Although less common in the elderly, headache is still a significant problem, with 10% of women and 5% of men reporting severe headaches at the age of 70 years.2,3 Etiology also varies with age. The incidence of primary headache disorders declines dramatically while the incidence of secondary headache disorders (such as mass lesions and temporal arteritis) increases with advancing age. Some secondary headache disorders, such as giant cell arteritis (GCA; temporal arteritis), occur almost exclusively in the elderly (Table 17.1).4 At least one primary headache disorder, the hypnic headache syndrome, is much more common in the elderly. Older patients are also more likely to have comorbid medical illness.5
Sleep and headache disorders
Published in S.R. Pandi-Perumal, Meera Narasimhan, Milton Kramer, Sleep and Psychosomatic Medicine, 2017
C. Rains Jeanetta, J. Steven Poceta, B. Penzien Donald
Hypnic headache is the sole example of a pure sleep-related headache (Table 8.1). Headaches tend to occur in the mid to latter portion of the sleep period and patients are abruptly awakened with pain (a.k.a. “alarm clock ” headache due to the tendency to occur at approximately the same time each night). A review pooled data from all published reports of hypnic headache between 1988 and 2014 (250 cases).6 Hypnic headache is relatively rare and accounts for less than 0.1% of all headaches and only 1.4% of geriatric headaches. The majority of cases were female (65%). The mean age of headache onset was 61 years, although younger patients were also found. Five cases of hypnic headache have been reported in children. The average attack duration was 162 ± 74 minutes, with a frequency of 21 ± 10 days per month, 68% were bilateral, 94% were moderate or severe, and a third of cases also had migraine. Two of the studies had also assessed sleep apnea and identified a high incidence of obstructive sleep apnea (73% and 83%). A few studies have reported an association between hypnic headaches and sleep disorders such as decreased sleep efficiency, restless legs, snoring, and sleep apnea.7–10
Neurology
Published in Keith Hopcroft, Instant Wisdom for GPs, 2017
Rare headache syndromesTrigeminal autonomic cephalalgias: The most ‘common’ is cluster, but others include hemicrania continua, paroxysmal hemicrania and short-lasting unilateral headache with conjunctival injection and tearing (SUNCT). They are all characterised by unilateral head pain, usually severe, lasting seconds to hours, associated with autonomic features (eye watering, red conjunctiva, ptosis, nasal stuffiness). Their management is different from other headache syndromes, so early identification is key (see www.ouchuk.org).Nummular headache: A well-demarcated area, usually in the parietal region, of mild to moderate pain with or without accompanying numbness. This is benign, but often resistant to medication.Hypnic headache: Typically older patients who are recurrently awoken by headache of mild to moderate severity, lasting up to 4 hours, with no other symptoms. Migraine is a more common cause of headache arising from sleep.
Temporal distribution of emergency room visits in patients with migraine and other headaches
Published in Expert Review of Neurotherapeutics, 2021
David García-Azorín, Jaime Abelaira-Freire, Esther Rodriguez-Adrada, Nuria González-García, Álvaro Planchuelo-Gómez, Ángel L. Guerrero, Jesús Porta-Etessam, Francisco J Martín-Sánchez
Despite that it is well known that many other headache disorders have a typical chronobiology, such as hypnic headache [14] and cluster headache [29], we could not inspect individual disorders due to the small number of cases. We did not control for factors that have demonstrated a clear influence on headache frequency, such as menstrual cycle [30], weather changes [31] or daily number of hours with light [32]. We also did not control for the influence of public events such as sporting events; however, due to the prolonged study period, variation from this type of influence is likely to have been minimal. We did not analyze the time gap between the headache onset and the ED visit, and we recommend that other researchers include this variable in long-term prospective studies and that they assess it specifically. Further studies should also assess differences in the duration of the ED stay and the patterns of hospitalization between the different headache patient groups.