Primary headaches during lifespan

Abstract

Primary headaches are one of the most prevalent neurological disorders and can occur during a wide range of lifespan. Primary headaches, especially migraine, are cyclic disorders with a complex sequence of symptoms within every headache attack. There is no systematic review of whether these symptoms changes during lifespan. Indeed, the clinical presentation of migraine shows an age-dependent change with a significantly shorter duration of the attacks and occurrence of different paroxysmal symptoms, such as vomiting, abdominal pain or vertigo, in childhood and, in contrast, largely an absence of autonomic signs and a more often bilateral headache in the elderly. The age-dependent differences in the clinical presentation are less distinct in cluster headache and, especially, in tension-type headache. The differences in the clinical presentation are in agreement with the idea that the connectivity of hypothalamic areas with different brainstem areas, especially the central parasympathetic areas, is important for the clinical manifestation of migraine, as well as, the change during lifespan.

Keywords: Adults; Aura; Children; Clinical symptoms; Cluster headache; Elderly; Hypothalamus; Migraine; Migraine-related syndromes; Parasympathetic; Sympathetic; Tension-type headache.

Fig. 1

Schematic and incomplete drawing of hypothalmic and cerebellar pathways involved in the modulation of migraine and probably also of periodic syndromes [, , , , –170]. The pathways are not differentiated in excitatory or functionally inhibitory pathways (e.g. the vagal connections to the spinal trigeminal nucleus are functionally inhibitory as it is also shown for the cerebellar pathways to the vestibular nucleus). green = hypothalamus, yellow = thalamus, grey = cerebellum; green = vestibular complex, blue = sensory trigeminal nucleus, pink = area postrema, rose = nucleus ambiguous (as part of the vagal complex)