generate barcode in c# asp.net Headaches in the Elderly in Microsoft Office

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Headaches in the Elderly
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In several surveys of an elderly population, headache with onset in this age period was found to be a prominent symptom in as many as one of six persons and more often to have serious import than headache in a younger population In one series of such patients reported by Pascual and Berciano, more than 40 percent were classi ed as having tension headaches (women more than men), and there was a wide variety of diseases in the others (posttraumatic
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CARDINAL MANIFESTATIONS OF NEUROLOGIC DISEASE
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headaches, cerebrovascular disease, intracranial tumors, cranial arteritis, severe hypertension) Cough-induced headaches and cluster headaches were present in some of the men New-onset migraine in this age group is a rarity Raskin has described a headache syndrome in older patients that shares with cluster headache a nocturnal occurrence (hypnic headache) It may occur with daytime naps as well However, it differs in being bilateral and unaccompanied by lacrimation and rhinorrhea Also, it differs from migraine Raskin has successfully treated a number of his patients with 300 mg of lithium carbonate at bedtime The nosologic position of this hypnic headache syndrome is undetermined Despite these considerations, the most treacherous and neglected cause of headache in the elderly is temporal (cranial) arteritis with or without polymyalgia rheumatica, as discussed further on
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Headache and Other Craniofacial Pain with Psychiatric Disease
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As mentioned several times in the above discussions, in our clinics the most common cause of generalized persistent headache, both in adolescents and adults, is depression or anxiety in one of its several forms The authors have also noted that many seriously ill psychiatric patients complain of frequent headaches that are not typically of the tension type These patients report unilateral or generalized throbbing cephalic pain lasting for hours every day or two The nature of these headaches, which in some instances resemble common migraine, is unsettled Others have delusional symptoms involving physical distortion of cranial structures As the psychiatric symptoms subside, the headaches usually disappear Odd cephalic pains, eg, a sensation of having a nail driven into the head (clavus hystericus), may occur in hysteria and raise perplexing problems in diagnosis The bizarre character of these pains, their persistence in the face of every known therapy, the absence of other signs of disease, and the presence of other manifestations of hysteria provide the basis for correct diagnosis Older children and adolescents sometimes have peculiar behavioral reactions to headache: screaming, looking dazed, clutching the head with an agonized look Usually, migraine is the underlying disorder, the additional manifestations responding to therapeutic support and suggestion
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or months Patients who have received anticoagulation are particularly at risk Diagnosis is established by CT and MRI Headache is a prominent feature of a complex syndrome comprising giddiness, fatigability, insomnia, nervousness, trembling, irritability, inability to concentrate, and tearfulness a syndrome that we have called posttraumatic nervous instability This type of headache and associated symptoms, which resemble the tension headache syndrome, are described fully in Chap 35, Craniocerebral Trauma The patient with posttraumatic nervous instability requires supportive therapy in the form of repeated reassurance and explanations of the benign nature of the symptoms, a program of increasing physical activity, and the use of drugs that allay anxiety and depression The early settlement of litigation, which is often an issue, works to the patient s advantage Tenderness and aching pain sharply localized to the scar of a scalp laceration represent in all probability a different problem and raise the question of a traumatic neuralgia Tender scars from scalp lacerations may be treated by repeated subcutaneous injections of local anesthetics, such as 5 mL of 1% procaine, which also acts as a diagnostic test With whiplash injuries of the neck, there may be unilateral or bilateral retroauricular or occipital pain, probably due to stretching or tearing of ligaments and muscles at the occipitonuchal junction or to a worsening of a pre-existent cervical arthropathy Much less frequently, cervical intervertebral discs and nerve roots are involved Under the heading of posttraumatic dysautonomic cephalalgia, Vijayan and Dreyfus have described a syndrome comprising severe, episodic, throbbing unilateral headaches sometimes accompanied by ipsilateral mydriasis and excessive sweating of the face, thus simulating migraine or cluster headache Between bouts of headache, a few of the patients showed partial ptosis and miosis as well as pharmacologic evidence of partial sympathetic denervation The condition followed injury to the soft tissues of the neck in the region of the carotid artery sheath The headaches did not respond to treatment with ergotamine, but prompt relief was obtained in each case with the beta-adrenergic blocking agent, propranolol
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