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What a headache          

                                    September 2008

WHAT A HEADACHE


headacheMost people have suffered a headache at some point in their lives and the good news is that as we get older, we may well suffer less. Adults over 50 are less likely to suffer from migraine which can be a major cause of headaches in younger people.

It is not all good news though - once we are over 50 it is more likely that any headache we do get is caused by an underlying disease, so as we get older it is more important to get headaches checked out by a medical practitioner.

Basically there are three types of headaches; a tension-type or muscular contraction headache; a migraine or vascular headache and cluster headaches. There are also headaches caused by illness.

Tension-type headaches are often brought on by stress, over-exertion, loud noise and other external factors. The typical tension-type headache is described as a tightening around the head and neck, and an accompanying dull ache.

Migraines are intense throbbing headaches occurring on one or both sides of the head. The pain can be accompanied by other symptoms such as nausea, sickness, blurred vision, and aversion to light, sound, and movement. Migraines can be triggered by food items, such as red wine, chocolate, and aged cheeses. For women the use of hormone replacement therapy after menopause can also bring on migraines.

Cluster headaches cause excruciating pain. The severe, stabbing pain usually centers around one eye. The headache lasts from 15 minutes to four hours and may recur several times in a day. Heavy smokers are more likely to suffer cluster headaches, which are also associated with alcohol.

Traditional theories about headaches link tension-type headaches to muscle contraction, and migraine and cluster headaches to the swelling of blood vessels.  Pain-sensitive structures in the head include blood vessel walls, membranous coverings of the brain, and scalp and neck muscles. Brain tissue itself has no sensitivity to pain. Therefore, headaches may result from contraction of the muscles of the scalp, face or neck; dilation of the blood vessels in the head; or brain swelling that stretches the brain's coverings. Involvement of specific nerves of the face and head may also cause characteristic headaches. Sinus inflammation can be a common cause of headache.

In adults over age fifty, a headache has a higher probability of being caused by an underlying disease than when it occurs in a younger person. More problems with blood flow and inflammation in people over fifty can lead to symptoms such as headache pain. Newer health worries may also exacerbate headaches that are already present. In addition, drugs taken for other health conditions such as blood pressure, for example, can cause rebound headaches.

Causes of headaches in a person over fifty can include arthritis, vascular changes in the brain; blood clots, brain tumours and pulmonary disease. There are also Hypnic headaches which occur in older adults and especially in people over 65. When a hypnic headache occurs, a person awakes during the night and experiences a headache that lasts for approximately half an hour. A typical pattern would be awakening once or twice during the night with head pain. The pain usually occurs on both sides of the head and stomach discomfort may also be present.

 

What to do

How Can Headaches Be Treated

Overall, treating migraines in older adults is similar to recommendations for all ages. Non-prescription guidelines such as monitoring diet, keeping a consistent sleep routine and icing the afflicted area on the head are still preferred.

Headache treatment is divided into two forms: abortive and prophylactic. Abortive treatment addresses a headache in progress, and prophylactic  treatment prevents headache occurring.

Tension-type and migraine headaches can be treated with over the counter remedies – products such as aspirin, acetaminophen, ibuprofen or naproxen. There are also extra strength medications such as excedrin which contains caffeine. Prescription medications such as antidepressants and muscle relaxants can address tension-type headaches, and ergotamine tartrate or sumatriptan can relieve or prevent migraines and can also be used for cluster headaches. There is some advice that inhaling pure oxygen can help cluster headaches as well.

If you are over 50 and experiencing headaches for the first time, it is important that you visit your doctor for a full medical check up. Without being unduly pessimistic, if you suffer a sudden strong headache, it is vital you obtain professional advice as a matter of urgency as it could be the sign of a situation that needs prompt medical intervention. Warning signs include:

  • The “worst headache of my life." This may indicate a hemorrhage from a ruptured aneurysm (swollen blood vessel) in the head or other neurological emergency.
  • Headache accompanied by one-sided weakness, numbness, visual loss, speech difficulty  or other signs. This may indicate a stroke. Migraines may include neurological symptoms.
  • Headache that becomes worse over a period of six months, especially if most prominent in the morning or if accompanied by neurological symptoms. This may indicate a brain tumour.
  • Sudden onset of headache. If accompanied by a fever and stiff neck can indicate meningitis.

Your doctor may send you for a neurological imaging test or a magnetic resonance imaging and there are many other tests that can be done to ensure the underlying causes of the headache are properly identified.

The main thing is not to accept that headaches are just another problem associated with growing older. Seek out advice – and you may find your headache becomes a thing of the past.

More information is available on:

www.headacheexpert.co.uk

www.healthline.com

www.nhsdirect.nhs.uk

 



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