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13 - Approach to the Elderly Patient with Headache in the Emergency Department

Published online by Cambridge University Press:  09 October 2017

Serena L. Orr
Children’s Hospital of Eastern Ontario, Ottawa
Benjamin W. Friedman
Albert Einstein College of Medicine, New York
David W. Dodick
Mayo Clinic, Phoenix, AZ
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The approach to the assessment and management of elderly patients presenting to the emergency department (ED) with headache is similar to the general approach to headache in this setting, in that the initial focus should be on differentiating primary vs. secondary headache and initiating an appropriate work-up where necessary. However, the index of suspicion for secondary headaches should be higher in this population, especially in the case of a new headache. Once secondary headache has been ruled out, the choice of pain interventions in this population requires a relatively greater emphasis on medication contraindications, side-effects, and medication interactions, given the general medical profile of the elderly patient. Unfortunately, evidence-based treatment recommendations are precluded by a lack of evidence specific to this population. In this chapter, we provide a general overview of the approach to the elderly patient with headache and a review of common secondary headaches in this population, and we discuss treatment options for primary headaches in the elderly.

Emergency Headache
Diagnosis and Management
, pp. 141 - 148
Publisher: Cambridge University Press
Print publication year: 2017

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