不可輕忽的老年人頭痛：個案報告

Dangerous Headache in the Elderly: A Case Report

10.29461/TGG.201205.0007

楊惟鈞(Wei-Chun Yang)；吳岱穎(Tai-Yin Wu)；杜興洋(Hsing-Yang Tu)；林文雄(Wen-Hsiung Lin)；李佳紋(Chia-Wen Li)；郭冠良(Kuan-Liang Kuo)

次發性頭痛 ； 硬腦膜下血腫 ； 老年人 ； secondary headache ； subdural hematoma ； elderly

台灣老年醫學暨老年學雜誌

7卷2期（2012 / 05 / 01）

139 - 148

繁體中文

64歲C先生最近三天有左側持續性頭痛，因痛到難以入眠，來家醫科求診；門診疑似為叢集性頭痛，但考慮病人年逾60歲，過去無偏頭痛病史且服用普拿疼後疼痛依然持續，故進一步電腦斷層檢查診斷為左側硬腦膜下血腫，於是安排手術治療。通常頭痛發生率會隨年齡下降。然而，次發性頭痛的發生率在老年人則會增加，如腦血管病變、腦瘤、頭部外傷並不少見，而多重用藥所引起的頭痛更是老年人次發性頭痛的大宗。除了詳盡的病史詢問、完整的理學與神經學檢查外，基層醫師尚須小心留意潛藏在臨床線索中致命性的次發性頭痛，以期正確治療。

Mr. C, a 64-years-old male, suffered from left-side persistent headache for 3 days. He sought help at our outpatient department of Family Medicine because the pain disturbed his sleep. The initial impression in the clinic was cluster headache. However, brain computed tomography (CT) was arranged owing to two reasons. First, the headache first occurred after his 60's and he had no similar past history. Second, the pain was hardly controllable by acetaminophen. CT examination showed left-side subdural hematoma. He then received cranial surgery and hematoma drainage.Although the incidence of headache decreases with age, the incidence of secondary headache in the elderly is higher than in the general population. The leading causes of secondary headache in the elderly were polypharmacy followed by cerebrovascular accident, head injury and brain tumor. In addition to complete history taking, thorough physical and neurological examination, general practitioners should be cautious about clinical clues signaling secondary headache in an aim towards correct treatment.