DRUG THERAPY Drugs & Aging I (I) : 48·56. 1991 1170·229X/91 /000 1·0048/$04 .50/0 © Adis International Limited. All rights reserved. ORAlooS Treatment of the Elderly Patient with Headache or Trigeminal Neuralgia Henry J. Kaminski and Robert L. Ruff Department of Neurology, Cleveland Department of Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, Ohio, USA Contents 48 Summary 49 I. Longstanding Recurrent Headaches 49 1.1 Migraine 50 I. I.I Migraine Treatment 50 1.2 Tension-Type Headaches 5 J 1.2.1 Treatment of Tension-Type Headache 52 1.3 Cluster Headache and Chronic Paroxysmal Hemicrania 52 1.3.1 Treatment of Cluster Headache and Paroxysmal Hemicrania 52 2. Recent-Onset Headaches 52 2.1 Headache Associated with Head Trauma 53 2.2 Headache Associated with Vascular Disorders 53 2.2.1 Cerebrovascular Disease 53 2.2.2 Giant Cell Arteritis 53 2.2.3 Arterial Hypertension 54 2.3 Intracranial Nonvascular Headaches 54 2.3.1 Chronic Meningitis 54 2.3.2 Intracranial Neoplasm 54 2.3.3 Subdural Haematoma 54 2.4 Headache Associated with Metabolic Disorder 55 2.5 Miscellaneous Causes of Headache 55 3. Trigeminal Neuralgia 55 3.1 Treatment of Trigeminal Neuralgia 56 4. Conclusions Summary The elderly as a whole suffer fewer headaches than the young. For the majority headache will represent a minor annoyance to be endured or treated with any available drug in the medicine chest. For some, migraine headaches or tension-type headaches become entwined with every daily activity. With the advent of modern pharmacology, headache can often be treated successfully. Trigeminal neuralgia is a source of particularly high morbidity among the elderly, but may be treated very satisfactorily with carbamazepine or baclofen. Paroxysmal hemicrania is exquisitely sensitive to indomethacin, while cluster headache patients receive relief from oxygen inhalation , corticosteroids or lithium.