Prevalence of headache in an elderly population: attack frequency, disability, and use of medication

Objectives-To assess the 1 year prevalence of tension-type headache (TTH), migraine headache (MH), and chronic daily headache (CDH), as well as of hea dache in general in a rural elderly population. Methods-A door to door two phase survey was carried out on all elderly (gre ater than or equal to 65 years) residents in three villages in central Ital y. Participants completed a standardised headache questionnaire and underwe nt a clinical evaluation by a neurologist. Headache diagnosis was made acco rding to the classification of the International Headache Society, with min or modifications for the classification of patients with MH with greater th an or equal to 15 attacks/month. Results-Eight hundred and thirty three (72.6%) of the 1147 eligible persons completed the study protocol. One year prevalence rates were respectively 44.5% for TTH, 11.0% for MH, 2.2% for symptomatic headaches, and 0.7% for t he remaining types of headache. The prevalence of headache in general was 5 1.0% because 62 residents had both TTH and MH attacks. Prevalence rates of patients with headache were higher in women than men (62.1% and 36.6% respe ctively) and decreased steadily with age for the 65-74, 75-84, and 85-96 ag e groups (56.7%, 45.2% and 26.1% respectively). Prevalence rates were 20.4% for patients with moderate to severe attacks, 18.0% for those with greater than or equal to1 attacks a month, and 4.4% for those with CDH. Of the 425 with headache 52 (12.2%) had not taken any drugs for their attacks in the previous year, 195 (45.9%) had taken them regularly, and 178 (41.9%) had ta ken them only when the headache pain interfered with activities that could not be postponed. Medication overuse was reported by 37.8% of patients with CDH with higher proportions for transformed migraine than for patients wit h chronic TTH (69.2% and 23.8% respectively, p=0.009) Conclusions-A consistent proportion of elderly people have primary headache s and consultation with a specialist is particularly recommended for patien ts with moderate or severe attacks, or with CDH.