50 岁以上头痛患者的特征和合并症：一项横断面研究。
Characteristics and comorbidities of headache in patients over 50 years of age: a cross-sectional study.
机构信息
Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
Department of General Surgery, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran.
出版信息
BMC Geriatr. 2022 Apr 10;22(1):313. doi: 10.1186/s12877-022-03027-1.
BACKGROUND
Although headache is a common complaint in younger individuals, it is one of the most common complaints among persons over the age of 50 and is a significant cause of morbidity. As there are differences in the causes and types of headache, the diagnosis and management of headache in older adults differ from that in younger individuals.
METHODS
In this cross-sectional study, 570 patients ≥ 50 years were recruited at a university affiliated tertiary headache center between 2016 and 2019. Demographic data, headache characteristics, and comorbid medical conditions were recorded. The presence of depression was explored using the Beck Depression Inventory. The patients were evaluated using the STOP-BANG scale to determine the risk of obstructive sleep apnea.
RESULTS
The mean age of the patients was 57.7 years. Seventy-three percent of the patients had primary headache disorders, with the most prevalent types being migraine, followed by tension-type headache. Secondary headaches were primarily the result of overuse of medication, cervical spine disease, and hypertension. Patients with medication-overuse headache were significantly more likely to suffer from hypothyroidism and gastrointestinal problems such as bleeding/ulcers. Irritable bowel syndrome was also more common in patients with medication-overuse headaches and migraines. The risk for obstructive sleep apnea was intermediate in 45.2% of the patients with hypertension-induced headache, but was lower in the majority of others. There was a high tendency for moderate-to-severe depression in the participants; however, the Beck Depression Inventory scores were significantly higher in medication-overuse headache patients.
CONCLUSION
Proper treatment of headache in middle-aged and older adults requires the recognition of secondary causes, comorbid diseases, and drug induced or medication overuse headaches. Special attention should be paid to depression and obstructive sleep apnea in such patients suffering from headache disorders.
背景
头痛虽是年轻人常见的主诉，但在 50 岁以上人群中较为常见，也是导致发病和致残的主要原因之一。由于头痛的病因和类型不同，老年人头痛的诊断和治疗与年轻人不同。
方法
本横断面研究于 2016 年至 2019 年在一所大学附属医院的三级头痛中心招募了 570 名年龄≥50 岁的患者。记录了人口统计学数据、头痛特征和合并的医疗状况。使用贝克抑郁量表评估抑郁的存在。使用 STOP-BANG 量表评估阻塞性睡眠呼吸暂停的风险。
结果
患者的平均年龄为 57.7 岁。73%的患者患有原发性头痛障碍，最常见的类型是偏头痛，其次是紧张型头痛。继发性头痛主要是由于药物过度使用、颈椎病和高血压引起的。药物过度使用性头痛患者更容易出现甲状腺功能减退和胃肠道问题，如出血/溃疡。肠易激综合征在药物过度使用性头痛和偏头痛患者中也更为常见。高血压性头痛患者中，阻塞性睡眠呼吸暂停的风险为中度至高度，而大多数其他患者的风险较低。参与者中有较高的中度至重度抑郁倾向；然而，药物过度使用性头痛患者的贝克抑郁量表评分明显更高。
结论
中年和老年患者头痛的适当治疗需要认识到继发性病因、合并疾病以及药物引起或药物过度使用性头痛。应特别注意此类头痛患者的抑郁和阻塞性睡眠呼吸暂停。
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