Her headaches were real and really severe. Hence, when the pain started - on the left side of her head, at the temple - and didn’t want to disappear, she decided she might need some medical help. Her healthcare provider was happy she did.
After detailed review of her medical history, noting that she had tenderness over the left temporal artery (a blood vessel along the side of the head), and recommending some additional examinations, Stephen Ross, MD, leader of staff at Santa Monica-UCLA Medical Center, Santa Monica, Calif., and a UCLA assistant clinical professor of medicine, diagnosed a condition called temporal arteritis, an inflammation of the blood vessels that may result in blindness, strokes, and even heart attack if left untreated. After receiving a course of corticosteroids to calm the inflammation, the woman recovered completely, with no vision or other health problems.
That case history from Ross is an example of the good news-bad news story of headaches in middle age and later. While those patients who have suffered from migraines or cluster headaches frequently when they were young adults find they have fewer or no episodes as they age, some middle-aged and older people who have taken headache medications very seldom will encounter what physicians describe as secondary headaches - those hat are caused by underlying disease or some structural problems. And these headaches necessitate medical attention to exclude serious problems.
The statistics
According to Joel R. Saper, MD, and Ann Arbor, generally, headaches are still a common symptom in older adults. Saper is a founder and director of the Michigan Head Pain & Neurological Institute, and Ann Arbor is a co-author of a report on geriatric headache, published in the December 2000 issue of the journal Geriatrics. Women aged 65 and more report headache to be the 10th most common symptom. Headache is also the 14th most common symptom in men in the same age, according to the report by Saper and his team, David M. Biondi, DO, director of the institute’s head pain division.
A lot of these headaches will result from nothing more than tension. But what is distressing to Saper is the number of patients in all age ranges who resign from seeking medical attention for their headaches.
"Around 50 per cent of patients who have headaches treat themselves alone," he tells WebMD. "We do not recommend doing this. Obviously, pain is a symptom that something is wrong. It may not be serious." But a person suffering from headache ought to talk to a physician as soon as possible and let the medical expert decide and diagnose, he claims.
According to Saper, older adults ought to expect their headache to be treated just as seriously as that in younger people. Some healthcare providers treat older adults’ headaches less aggressively, he explains, chalking up the pain to depression or just a fact of life with age.
The evaluation
Older adults who suffer from severe headache for the first time after age 50 require a thorough medical examination, claims Saper, who has co-authored a textbook, ‘Handbook of Headache Management’. The doctor should receive a detailed and precise medical history.
The tests that may be considered include: computed tomography (CT) or magnetic resonance imaging (MRI), along with examination of blood and urine and vision exams. Heart tests may be recommended if the headache is exercise-induced, which may indicate heart disease.
The diagnosis laundry list
What might the reason for severe headaches in older adults be? Apart from heart disease, if the headache is exercise-induced, or temporal arteritis, suffered by Ross’ patient, there is a variety of other possibilities.
There are some headaches that are induced by medicines for the treatment of high blood pressure, Parkinson’s disease, chronic obstructive lung disease, and other conditions that are more common with age. Hormone replacement therapy may be connected with midlife headache as well, Saper explains.
"I see many older women on hormone replacement therapy who experienced their first migraine after beginning it," he claims. But due to the fact that HRT provides other benefits such as a decrease of heart disease risk, Saper does not normally recommend that women put an end to taking the treatment.
Headaches are also likely to be a symptom of particular types of strokes.
Subdural hematomas, or bleeding in the brain, are another possibility.
One of the patients of Ross woke up in the dead of the night to go to the bathroom, fell and struck her head, but went back to sleep, due to the fact that she was not in serious pain. After three days, she sought medical attention because of severe headache. The diagnosis was as follows: subdural hemotoma. "She ended up having to have neurosurgery," Ross claims. "She was drilled several small holes to alleviate the pressure."
Hypnic headache is another, but more remote possibility. These headaches are marked by painful attacks that take place at night, waking the person up. Pain appears on both sides of the head and may be accompanied by nausea. There are frequently one or two episodes per night, each of them lasts from five to sixty minutes. However, the good news is that a dose of lithium prevents further attacks, Saper has discovered.
Brain tumor is a remote possibility. "In my experience, perhaps less than 1 per cent of headaches are associated with a brain tumor," Ross claims. Still, worries about a brain tumor bring in many patients. Trying to sound casual, they’ll ask him: "Doctor, you don’t think I have a brain tumor, do you?" He can be reassuring: Most probably they do not.
According to Saper, he is less probable to hear the worries concerning brain tumors, mostly due to the fact that by the time patients get to their specialized clinics, they already have seen their primary care physician.
"But everyone is afraid when their headache hurts," he states.
Progress in treatment
Nowadays, there’s much more understanding of headache problem in older adults than in the past years, Saper says. For example, scientists have discovered lately that the neck may play an essential role in headaches in the future of a patient. Cervical arthritis, for example, might be a headache trigger and can be alleviated by treatment of the arthritis.
"Another trend has been the recognition that when people get older, some brain chemicals are reduced," Saper explains. Therefore, the headaches in those patients do not result from depression - a common diagnosis in the elderly patients - but to a decline in those substances. The headaches appear to be more physiological than psychological.
Saper anticipates a significant improvement in the treatment of headache, due to the fact that more and more studies are done on specific kinds of headaches. Several medicines that are currently being researched look promising, he claims, since they target the specific brain pathway that triggers the headache.
