Original article
Headache in the elderly: a series of 262 patients
Cefaleas en la persona mayor: características de una serie de 262 pacientes
M. Ruiz, M.I. Pedraza, C. de la Cruz, J. Barón, I. Muñoz, C. Rodríguez, M. Celorrio, P. Mulero, S. Herrero, A.L. Guerrero
Corresponding author
Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
Read
6171
Timeswas read the article
1376
Total PDF
4795
Total HTML
Share statistics
array:24 [ "pii" => "S2173580814000868" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2013.07.004" "estado" => "S300" "fechaPublicacion" => "2014-07-01" "aid" => "541" "copyright" => "Sociedad Española de Neurología" "copyrightAnyo" => "2013" "documento" => "article" "crossmark" => 0 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Neurologia. 2014;29:321-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2708 "formatos" => array:3 [ "EPUB" => 74 "HTML" => 1923 "PDF" => 711 ] ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0213485313001977" "issn" => "02134853" "doi" => "10.1016/j.nrl.2013.07.007" "estado" => "S300" "fechaPublicacion" => "2014-07-01" "aid" => "541" "copyright" => "Sociedad Española de Neurología" "documento" => "article" "crossmark" => 0 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Neurologia. 2014;29:321-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8460 "formatos" => array:3 [ "EPUB" => 74 "HTML" => 7208 "PDF" => 1178 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Cefaleas en la persona mayor: características de una serie de 262 pacientes" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "321" "paginaFinal" => "326" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Headache in the elderly: Characteristics in a series of 262 patients" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1174 "Ancho" => 2424 "Tamanyo" => 106129 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Comparación entre los porcentajes de cefaleas en jóvenes y mayores. Del 1 al 14, grupos de la CIC-2.</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Ap: apéndice.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Ruiz, M.I. Pedraza, C. de la Cruz, J. Barón, I. Muñoz, C. Rodríguez, M. Celorrio, P. Mulero, S. Herrero, A.L. Guerrero" "autores" => array:10 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Ruiz" ] 1 => array:2 [ "nombre" => "M.I." "apellidos" => "Pedraza" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "de la Cruz" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Barón" ] 4 => array:2 [ "nombre" => "I." "apellidos" => "Muñoz" ] 5 => array:2 [ "nombre" => "C." "apellidos" => "Rodríguez" ] 6 => array:2 [ "nombre" => "M." "apellidos" => "Celorrio" ] 7 => array:2 [ "nombre" => "P." "apellidos" => "Mulero" ] 8 => array:2 [ "nombre" => "S." "apellidos" => "Herrero" ] 9 => array:2 [ "nombre" => "A.L." "apellidos" => "Guerrero" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173580814000868" "doi" => "10.1016/j.nrleng.2013.07.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580814000868?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485313001977?idApp=UINPBA00004N" "url" => "/02134853/0000002900000006/v1_201407160920/S0213485313001977/v1_201407160920/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2173580814000856" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2013.07.003" "estado" => "S300" "fechaPublicacion" => "2014-07-01" "aid" => "540" "copyright" => "Sociedad Española de Neurología" "documento" => "article" "crossmark" => 0 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Neurologia. 2014;29:327-33" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2553 "formatos" => array:3 [ "EPUB" => 46 "HTML" => 1968 "PDF" => 539 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Longitudinal evaluation using FP-CIT in patients with parkinsonism" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "327" "paginaFinal" => "333" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evaluación longitudinal con FP-CIT en pacientes con parkinsonismo" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 880 "Ancho" => 1800 "Tamanyo" => 201260 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Initial study (A) and monitoring study (B) from patient 6.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.D. Martínez-Valle Torres, S.J. Ortega Lozano, M.J. Gómez Heredia, T. Amrani Raissouni, E. Ramos Moreno, P. Moya Espinosa, J.M. Jiménez-Hoyuela" "autores" => array:7 [ 0 => array:2 [ "nombre" => "M.D." "apellidos" => "Martínez-Valle Torres" ] 1 => array:2 [ "nombre" => "S.J." "apellidos" => "Ortega Lozano" ] 2 => array:2 [ "nombre" => "M.J." "apellidos" => "Gómez Heredia" ] 3 => array:2 [ "nombre" => "T." "apellidos" => "Amrani Raissouni" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Ramos Moreno" ] 5 => array:2 [ "nombre" => "P." "apellidos" => "Moya Espinosa" ] 6 => array:2 [ "nombre" => "J.M." "apellidos" => "Jiménez-Hoyuela" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213485313001965" "doi" => "10.1016/j.nrl.2013.07.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485313001965?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580814000856?idApp=UINPBA00004N" "url" => "/21735808/0000002900000006/v1_201407240029/S2173580814000856/v1_201407240029/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Headache in the elderly: a series of 262 patients" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "321" "paginaFinal" => "326" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Ruiz, M.I. Pedraza, C. de la Cruz, J. Barón, I. Muñoz, C. Rodríguez, M. Celorrio, P. Mulero, S. Herrero, A.L. Guerrero" "autores" => array:10 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Ruiz" ] 1 => array:2 [ "nombre" => "M.I." "apellidos" => "Pedraza" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "de la Cruz" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Barón" ] 4 => array:2 [ "nombre" => "I." "apellidos" => "Muñoz" ] 5 => array:2 [ "nombre" => "C." "apellidos" => "Rodríguez" ] 6 => array:2 [ "nombre" => "M." "apellidos" => "Celorrio" ] 7 => array:2 [ "nombre" => "P." "apellidos" => "Mulero" ] 8 => array:2 [ "nombre" => "S." "apellidos" => "Herrero" ] 9 => array:4 [ "nombre" => "A.L." "apellidos" => "Guerrero" "email" => array:1 [ 0 => "gueneurol@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cefaleas en la persona mayor: características de una serie de 262 pacientes" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1168 "Ancho" => 2421 "Tamanyo" => 115260 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Comparison of headache percentages between younger and older patient groups. ICHD-2 groups from 1 to 14. Apx: appendix.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The Spanish population is ageing. According to data from INE, Spain's National Statistics Institute, 17.33% of that country's citizens were aged 65 years or older in 2011. It is estimated that the percentage will reach 20.35% by 2021.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The elderly, who require frequent medical attention, therefore constitute a large segment of our society. Multiple epidemiological studies show that headaches are more frequent among younger patients and that their prevalence decreases in older segments of the population.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> Despite this fact, the impact of headaches on the elderly is considerable.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Most headaches diagnosed in elderly individuals are classified as primary headaches, and they are mainly migraines and tension headaches. In patients aged 65 and older, migraine frequency decreases and headache symptoms become more atypical and more commonly accompanied by aura.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–9</span></a> While secondary headaches remain more infrequent than primary headaches overall, they are more significant in this age group, accounting for 15% of the total headaches in the elderly, compared to 1% to 6% among patients younger than 65.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> It is therefore necessary to take additional precautions in light of the potentially severe underlying causes in this segment of the population.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Some headaches are characteristic of and nearly exclusive to the elderly, including hypnic headaches and headaches secondary to giant cell arteritis. We must therefore be mindful of these entities when treating elderly patients.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The purpose of this study is to describe the characteristics of a series of elderly patients cared for in a specialist headache unit at a tertiary hospital. In doing so, we attempt to provide epidemiological data to help promote a more thorough understanding of these patients, as well as better patient management.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">During a period spanning 4 years and 5 months (January 2008-May 2012), we prospectively registered all patients attended in the headache unit indicated above. We first recorded demographic data (age and sex). Headaches were coded according to ICHD-2 criteria.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> If the patient met criteria for multiple types of headache, all types were considered and coded.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Researchers also analysed clinical data, such as age at onset of each syndrome, impact of migraine as measured by the HIT-6 scale, and symptomatic and preventive treatments used before the patient had been referred to the headache unit. Doctors indicated the complementary studies that were considered necessary in each case according to the patient's individual characteristics.</p><p id="par0035" class="elsevierStylePara elsevierViewall">We compared the distribution of headaches in this group with that among patients younger than 65 who were seen in this unit during the inclusion period. The mean was used as the measure of central tendency in the results, except in the case of age which shows the median. Lastly, we analysed headache distribution in the subgroup of patients aged 75 years or older.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">Two hundred sixty-two patients (189 women, 73 men) aged 65 years and older, comprising 14% of a total of 1868 patients, made an initial visit to the headache unit during the period specified above. The median age was 72 years (range, 65-94).</p><p id="par0045" class="elsevierStylePara elsevierViewall">Primary care referred 149 cases (56.8%), while 70 were referred by general neurology clinics (26.7%); 35 patients (13.4%) were in-hospital consultations referred by other departments. Eight patients (3.1%) were seen without a scheduled appointment and most were family members of hospital employees.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The median age of onset of the headaches for which patients sought medical attention was 65.5 (range, 10-93). Onset of headaches occurred after the age of 65 years in 136 cases (51.9%).</p><p id="par0055" class="elsevierStylePara elsevierViewall">The mean score on the HIT-6 scale in these patients was 54<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.2 (range, 40-72); values exceeded 55 in 44.4% of the cases.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Most patients (90.5%) had been taking some sort of symptomatic treatment for headache relief, while only 32.9% had been taking preventive treatment. Complementary studies had been ordered for 33.1% of the elderly patients in our series; most were neuroimaging studies or laboratory analyses, and tests measuring erythrocyte sedimentation rate (ESR) were particularly common.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In this elderly population, 99 patients (68 women and 31 men, 37.8%) were aged 75 years or older. This segment represents 5.3% of our total sample.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In the group of 262 patients aged 65 or older, researchers coded 362 headache episodes. Primary headaches, or groups 1 through 4 in the ICHD-2 classification, accounted for 225 (62.2%). The most frequent groups were 2 (tension-type headache) with 104 cases (28.7%) and 1 (migraine) with 86 cases (23.8%). There were 58 headache episodes (16%) coded as secondary headaches in groups 5 through 12; 26 in group 13 (cranial neuralgia, 7.2%), 23 in group 14 (other headaches, 6.4%) and 30 in the ICHD-2 appendix (8.3%). Regarding secondary headaches, the most frequent were attributed to substances (39 cases), followed by those associated with cranial trauma (11 headaches). Only the 3 headaches classified in group 6 (due to vascular disorders) can be considered secondary to severe causes. Percentages for each group are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Headaches considered typical at older ages were also present among the diagnoses assigned to our elderly population. We recorded 41 cases of chronic migraine, 6 of hypnic headache, 4 cases of occipital neuralgia, 2 cases of short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), 1 case of cervicogenic headache, 1 primary cough headache, and 2 headaches related to temporal arteritis.</p><p id="par0080" class="elsevierStylePara elsevierViewall">We compared the distribution of headaches in the elderly patients series with that in the 1606 patients younger than 65 (1159 women and 447 men) attended in the same unit during the inclusion period. Researchers coded 2522 headaches. Of this total, 1849 (73.3%) were recorded as primary headaches, 290 (11.5%) were classified as secondary headaches, 86 (3.4%) were assigned to group 13, 38 (1.5%) were classified in group 14, and 259 (10.3%) were coded in the appendix. In younger patients, we find higher percentages of tension-type headaches, secondary headaches, neuralgias, and other headaches (unspecified or unclassifiable). We also find a higher percentage of trigeminal-autonomic headaches. <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> shows the comparison between older and younger patients.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Lastly, we compare the headache distribution between the younger segment of the elderly population (65-75 years) and the very elderly population (75 years or more). In the latter group, researchers coded 127 headache events; most were primary headaches (74, 58.3%). A striking feature in the analysis of the two populations is that tension-type headaches are even more predominant in the very elderly population. A complete comparison by ICHD-2 diagnostic group is provided in <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">It is a known fact that headache prevalence decreases in older age groups. The review of European epidemiological studies on headaches by Stovner et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> offers a diagram of this decreasing tendency in each age group after adulthood. For example, these authors calculate a yearly headache prevalence of 35% for patients aged 60 to 70, but 25% among patients aged 70 to 80.</p><p id="par0095" class="elsevierStylePara elsevierViewall">However, despite this decrease, headaches remain an important problem among the elderly; half of this population may experience different types of headaches<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,14–16</span></a> and one in 5 elderly patients has recurrent headaches.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">In our study, patients aged 65 or older made up 14% of the population treated in a specialist headache unit. A similar study in Italy shows that elderly patients made up 6.4% of the population,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> but as that study does not describe where its patients came from, we cannot attempt to explain the difference in percentages. However, the percentage of patients aged 75 and older treated in our unit is comparable to that recorded in a general neurology clinic in our setting.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Most authors point out the higher percentage of secondary headaches among elderly individuals.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,11,19,20</span></a> Researchers have proposed several causes of secondary headaches in this age group. Our results coincide with those from other studies in that the higher rate of secondary headaches in older than in younger patients is mainly explained by ICHD-2 classification groups 5 (headache attributed to head and/or neck trauma) and 8 (headache attributed to a substance).<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21–23</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Headaches secondary to serious conditions were uncommon in our series and complementary testing was only necessary for about a third of our patient total (33.1%). It seems clear, at least in our sample, that the patient's medical history and physical examination provide the fundamental basis for diagnosing headaches in this age group as well as in others.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Giant cell arteritis is considered an infrequent disease; its incidence rate is between 1 and 30/100<span class="elsevierStyleHsp" style=""></span>000 patients aged 50 or older (between 3 and 16/100<span class="elsevierStyleHsp" style=""></span>000 in Spain).<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Headache is the first symptom of this disease in almost half the affected patients, and it will appear at some point during the course of the disease in 90%.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25–28</span></a> Our series only identified 2 cases of headache related to temporal arteritis (0.76% of the total population aged 65 or older). One of our criteria for referring patients to our unit from primary care is an ESR measurement in patients aged 50 and older. This requirement is also stated in official guidelines published by the Spanish Society of Neurology.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> For this reason, these patients are probably diagnosed in primary care centres or internal medicine consultations due to headache or other accompanying symptoms. Only a small minority of these patients will be treated by a specialist headache unit; the fact that only 0.62% of the headache cases in patients aged 75 or older and visiting in a general neurology consultation were related to temporal arteritis<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> supports this hypothesis.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The most frequent diagnosis in our series was tension-type headache (28.7% of the total). Studies carried out to determine the prevalence of tension-type headache in the general population have obtained highly variable results, ranging from a yearly prevalence rate of 86.5% to a lifetime rate of 11.5%.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Regarding more specific studies in the age group in question, annual prevalence rates of 16% to 44% have been established in individuals aged 50 and over.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,17,30–32</span></a> Presence of tension-type headache is even higher among patients older than 75 years,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,18</span></a> as we also observed in our series. According to these results, and considering the vast difference between the percentage of tension-type headaches in younger and in older patients, we can state that this entity is typical in the elderly.</p><p id="par0125" class="elsevierStylePara elsevierViewall">At 23.8%, the second most common diagnosis in our population of elderly patients was migraine. Multiple epidemiological studies have shown that, after a peak in frequency (whether unimodal or bimodal) between the ages of 20 and 50,<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,11,33</span></a> migraine prevalence decreases progressively in older age ranges. For patient populations aged 65 and older, the annual migraine prevalence rate is approximately 10%.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,17</span></a> This percentage is higher, with values resembling those in our study, in a specialist headache unit.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> In patients older than 75, as we also observed in our population, percentages continue to decrease.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Forty-one patients in our series (15.6%) met diagnostic criteria for chronic migraine<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a>; transformation of episodic migraine to chronic migraine is well-documented in elderly patients.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19,21,35,36</span></a> It is important to note that migraines change with age, and this may make diagnosis more difficult in elderly patients. Characteristics such as pulsatility, associated photophobia or phonophobia, exacerbation with exercise, and high intensity will diminish over time.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> On the other hand, autonomic symptoms and bilateral pain are more common in elderly patients.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The importance and significance of migraine with aura in elderly patients remains a controversial topic. Firstly, it is uncommon to find de novo migraines in patients older than 65, but in cases of onset in middle age, migraine with aura may occur over longer time periods. This occurs because the patient maintains, at an older age, the mechanism responsible for cortical spreading depression, while losing the propensity for neurovascular inflammation and the pain it produces.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,9</span></a> We identified only 3 patients with migraine with aura in our series, and only one case experienced onset after the age of 55. Differential diagnosis for transient ischaemic attack and migraine with aura is not always easy in patients in this age group. Visual and sensory changes with symptom progression are more suggestive of aura, whereas neurovascular events tend to show a sudden onset.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">37,38</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Hypnic headaches are another type of primary headache present in our sample in 6 cases (1.7%). Although they are uncommon outside of this age range,<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> both our group and other authors have seen cases of onset before the age of 65.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">SUNCT is an uncommon entity; its prevalence is 6.6/100<span class="elsevierStyleHsp" style=""></span>000 and its annual incidence rate is 1.2/100<span class="elsevierStyleHsp" style=""></span>000.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> The syndrome is characterised by multiple daily attacks of intense unilateral pain of short duration (less than 2<span class="elsevierStyleHsp" style=""></span>minutes). The headaches affect the periorbital region and they are associated with homolateral cranial autonomic symptoms. Typical age of onset is about 50 years.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> This entity appeared in 2 patients in our series.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Cervicogenic headache is considered a typical disease in the elderly, but it only appears in one patient in our series. Many of these patients will seek medical care in rheumatology or traumatology departments; on the other hand, ICHD-2 criteria for this entity are extremely strict. It will be necessary to review the prevalence of this type of headache using the criteria in the new third edition of the classification; these criteria place less importance on the requirement of pain resolution after treatment and more importance on the manoeuvres that trigger the pain.</p><p id="par0150" class="elsevierStylePara elsevierViewall">We noticed that our population of patients aged 65 and older showed a high percentage of neuralgias (group 13 in ICHD-2); this was even higher in those older than 75. The most common type of neuralgia in our series is essential trigeminal neuralgia (8 patients).</p><p id="par0155" class="elsevierStylePara elsevierViewall">The percentage of headaches in group 14 (not classified or unspecified) is also higher in our population; at least in this population, the older the patient, the more difficult it is to identify or classify the headaches he or she experiences. This may be due to the added difficulty of taking down a patient history from some patients with cognitive impairment; better care for headache sufferers in this age range might help us describe other syndromes that are typical in the elderly.</p><p id="par0160" class="elsevierStylePara elsevierViewall">In conclusion, headache is a common motive for a neurological consultation among the elderly. Although one of our study's limitations may be a selection bias, these results from a series of patients aged 65 and older who visited a specialist unit due to headaches show that primary headaches are the most frequent type in this age group, with tension-type headache being the most common entity. According to our results, a group of entities that include headache related to medication problems, chronic migraine, and neuralgia may be considered typical in these patients. Correctly identifying these entities on a case-by-case basis will help us offer our elderly patients the most appropriate treatment.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres354333" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction" 2 => "Methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec335681" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres354334" "titulo" => array:5 [ 0 => "Resumen" 1 => "Introducción" 2 => "Métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec335682" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 9 => array:2 [ "identificador" => "xack87456" "titulo" => "Acknowledgements" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-03-25" "fechaAceptado" => "2013-07-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec335681" "palabras" => array:6 [ 0 => "Hypnic headache" 1 => "Tension-type headache" 2 => "International Classification of Headache Disorders-2" 3 => "Epidemiology" 4 => "Elderly" 5 => "Migraine" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec335682" "palabras" => array:6 [ 0 => "Cefalea hípnica" 1 => "Cefalea tensional" 2 => "Clasificación Internacional de Cefaleas-2" 3 => "Epidemiología" 4 => "Personas mayores" 5 => "Migraña" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Although headache prevalence decreases in patients older than 65, headaches are a common complaint and their different clinical and therapeutic features must be understood. This article analyses the clinical characteristics of elderly patients treated in an outpatient headache unit.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We collected demographic and clinical data from patients treated in a tertiary hospital headache unit between January 2008 and May 2013. Headaches were codified according to the International Classification of Headache Disorders, 2nd edition (ICHD-2).</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Of a total of 1868 patients treated, 262 patients (14%, 189 women and 73 men) were older than 65 years. Ninety-nine (68 women, 31 men, 5.3% of the total) were over 75. Headaches began after the age of 65 in only 136 patients (51.9%). The 362 headaches were codified as follows: 23.8% as Group 1 (migraine) and 28.7% as Group 2 (tension-type headache). We diagnosed 58 (16%) secondary headaches; 26 (7.2%) were classified as Group 13 (cranial neuralgias) and 23 (6.4%) in Group 14 (other headaches). Symptomatic medication overuse was detected in 38 patients (14.5%). We also identified headaches considered typical in the elderly, including chronic migraine (41 cases), hypnic headache (6), occipital neuralgia (4), SUNCT (2), cervicogenic headache (1), primary cough headache (1), and giant cell arteritis (2).</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Elderly patients were frequently treated in our outpatient headache unit. Tension-type headache was the most common diagnosis in this population. Geriatric headache syndromes such as hypnic headache or occipital neuralgia were also represented in our series.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Aunque la prevalencia de las cefaleas disminuye en las personas mayores (≥ 65 años), son causa importante de consulta, con particularidades diagnósticas y terapéuticas que es necesario conocer. Analizamos las características de este grupo etario en una consulta de cefaleas.</p> <span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Recogimos las variables demográficas y clínicas de los pacientes atendidos en una consulta de cefaleas de un hospital terciario (enero del 2008-mayo del 2012). Las cefaleas se codificaron según la Clasificación Internacional de Cefaleas, 2.<span class="elsevierStyleSup"><span class="elsevierStyleItalic"><span class="elsevierStyleUnderline">a</span></span></span> edición (CIC-2).</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Doscientos sesenta y dos pacientes (189 mujeres, 73 varones) con ≥ 65 años fueron atendidos sobre un total de 1.868 (14%); 99 (68 mujeres, 31 varones, 5,3% del total) superaban los 75 años. Inicio de la cefalea tras los 65 años en 136 casos (51,9%). Se codificaron 362 cefaleas, el 23,8% en el grupo 1 de CIC-2 (migrañas) y el 28,7% en el grupo 2 (cefalea tensional). Se diagnosticaron 59 (16%) cefaleas secundarias; 26 (7,2%) se encuadraron en el grupo 13 (neuralgias) y 23 (6,4%) en el grupo 14 (no clasificables). En 38 casos (14,5%) había sobreuso de medicación sintomática. Entre las cefaleas típicas de esta edad identificamos 41 migrañas crónicas, 6 cefaleas hípnicas, 4 neuralgias del occipital, 2 SUNCT, una cefalea cervicogénica, una cefalea primaria de la tos y 2 arteritis de la temporal.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El porcentaje de personas mayores atendidas en una consulta de cefaleas es elevado. La cefalea tensional es la más frecuente en esta población. Cefaleas típicas de esta edad, como la cefalea hípnica o la neuralgia del occipital, están presentes.</p>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ruiz M, Pedraza MI, de la Cruz C, Barón J, Muñoz I, Rodríguez C, et al. Cefaleas en la persona mayor: características de una serie de 262 pacientes. Neurología. 2014;29:321–326.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Part of this study was presented as an oral communication at the 64th Annual Meeting of the Spanish Society of Neurology, Barcelona, November 2012.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 745 "Ancho" => 1594 "Tamanyo" => 63102 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Percentage of the 362 headaches classified by ICHD-2 group. From 1 to 14, ICHD-2 groups. Apx: appendix; ICHD-2: International Classification of Headache Disorders, 2nd edition.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1168 "Ancho" => 2421 "Tamanyo" => 115260 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Comparison of headache percentages between younger and older patient groups. ICHD-2 groups from 1 to 14. Apx: appendix.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1232 "Ancho" => 2492 "Tamanyo" => 129823 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Comparison of headache percentages between patients aged 65 and 75 and patients aged 75 and up. From 1 to 14, ICHD-2 groups. Apx: appendix.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:41 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Instituto Nacional de Estadística. Available from: <a id="intr0010" class="elsevierStyleInterRef" href="http://www.ine.es/censos2011datos/cen11datosresultados.htm">http://www.ine.es/censos2011datos/cen11datosresultados.htm</a> [accessed May 2013]." ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of headache in Europe" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L.J. Stovner" 1 => "J.A. Zwart" 2 => "K. Hagen" 3 => "G.M. Terwindt" 4 => "J. Pascual" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-1331.2006.01184.x" "Revista" => array:6 [ "tituloSerie" => "Eur J Neurol" "fecha" => "2006" "volumen" => "13" "paginaInicial" => "333" "paginaFinal" => "345" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16643310" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of headache in an elderly population: attack frequency, disability, and use of medication" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Prencipe" 1 => "A.R. Casini" 2 => "C. Ferretti" 3 => "M. Santini" 4 => "F. Pezzella" 5 => "N. Scaldaferri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Neurol Neurosurg Psychiatry" "fecha" => "2001" "volumen" => "70" "paginaInicial" => "377" "paginaFinal" => "381" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11181862" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of headache in Puerto Rico" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H. Miranda" 1 => "G. Ortiz" 2 => "S. Figueroa" 3 => "D. Peña" 4 => "J. Guzmán" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Headache" "fecha" => "2003" "volumen" => "43" "paginaInicial" => "774" "paginaFinal" => "778" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12890132" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A 13-year long-term outcome study of elderly with chronic daily headache" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.L. Fuh" 1 => "S.J. Wang" 2 => "S.R. Lu" 3 => "P.H. Tsai" 4 => "T.H. Lai" 5 => "K.L. Lai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-2982.2008.01637.x" "Revista" => array:6 [ "tituloSerie" => "Cephalalgia" "fecha" => "2008" "volumen" => "28" "paginaInicial" => "1017" "paginaFinal" => "1022" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18624806" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Age-dependent prevalence and clinical features of migraine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.E. Bigal" 1 => "J.N. Liberman" 2 => "Lipton R.B. Lipton" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1212/01.wnl.0000225186.76323.69" "Revista" => array:6 [ "tituloSerie" => "Neurology" "fecha" => "2006" "volumen" => "67" "paginaInicial" => "246" "paginaFinal" => "251" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16864816" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Migraine in the elderly: a comparison with migraine in young adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K.M. Martins" 1 => "C.A. Bordini" 2 => "M.E. Bigal" 3 => "J.G. Speciali" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1526-4610.2006.00343.x" "Revista" => array:6 [ "tituloSerie" => "Headache" "fecha" => "2006" "volumen" => "46" "paginaInicial" => "312" "paginaFinal" => "316" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16492241" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Migraine prevalence by age and sex in the United States: a life-span study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T.W. Victor" 1 => "X. Hu" 2 => "J.C. Campbell" 3 => "D.C. Buse" 4 => "R.B. Lipton" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0333102409355601" "Revista" => array:6 [ "tituloSerie" => "Cephalalgia" "fecha" => "2010" "volumen" => "30" "paginaInicial" => "1065" "paginaFinal" => "1072" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20713557" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary headache in the elderly in South-East Asia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.L. Tai" 1 => "J.S. Jivanadham" 2 => "C.T. Tan" 3 => "V.K. Sharma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10194-012-0434-9" "Revista" => array:6 [ "tituloSerie" => "J Headache Pain" "fecha" => "2012" "volumen" => "13" "paginaInicial" => "291" "paginaFinal" => "297" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22422347" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Experience in the diagnosis of headaches that start in elderly people" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Pascual" 1 => "J. Berciano" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Neurol Neurosurg Psychiatry" "fecha" => "1994" "volumen" => "57" "paginaInicial" => "1255" "paginaFinal" => "1257" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7931391" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cefalea en situaciones especiales" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Mateos Marcos" 1 => "M.D. Castro Vilanova" 2 => "J. González Menacho" 3 => "A.L. Guerrero Peral" 4 => "S. Mederer Hengstl" 5 => "M. Rufo Campos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Guía oficial para el diagnóstico y tratamiento de las cefaleas 2011" "paginaInicial" => "221" "paginaFinal" => "249" "serieFecha" => "2011" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Headache in the elderly: a clinical study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Lisotto" 1 => "F. Mainardi" 2 => "F. Maggioni" 3 => "F. Dainese" 4 => "G. Zanchin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Headache Pain" "fecha" => "2004" "volumen" => "5" "paginaInicial" => "36" "paginaFinal" => "41" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The International Classification of Headache Disorders, 2nd edition" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Headache Classification Subcommittee of the International Headache Society" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Cephalalgia" "fecha" => "2004" "volumen" => "24" "numero" => "Suppl. 1" "paginaInicial" => "9" "paginaFinal" => "160" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14979299" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Headache in the elderly" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.A. Walker" 1 => "M.C. Wadman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cger.2007.01.009" "Revista" => array:6 [ "tituloSerie" => "Clin Geriatr Med" "fecha" => "2007" "volumen" => "23" "paginaInicial" => "291" "paginaFinal" => "305" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17462518" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of headache in the entire population of a small city in Brazil" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.S. Junior" 1 => "A. Krymchantowski" 2 => "P. Moreira" 3 => "L. Vasconcelos" 4 => "R. Gomez" 5 => "A. Teixeira" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1526-4610.2009.01435.x" "Revista" => array:6 [ "tituloSerie" => "Headache" "fecha" => "2009" "volumen" => "49" "paginaInicial" => "895" "paginaFinal" => "899" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19438729" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The prevalence of headache among elderly in a low-income area of São Paulo, Brazil" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I.M. Benseñor" 1 => "P.A. Lotufo" 2 => "A.C. Goulart" 3 => "P.R. Menezes" 4 => "M. Scazufca" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-2982.2007.01507.x" "Revista" => array:6 [ "tituloSerie" => "Cephalalgia" "fecha" => "2008" "volumen" => "28" "paginaInicial" => "329" "paginaFinal" => "333" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18294252" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of primary headaches in Italian elderly: preliminary data from the Zabút Aging Project" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Camarda" 1 => "R. Monastero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s100720300058" "Revista" => array:7 [ "tituloSerie" => "Neurol Sci" "fecha" => "2003" "volumen" => "24" "numero" => "Suppl. 2" "paginaInicial" => "S122" "paginaFinal" => "S124" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12811609" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cefalea en los muy ancianos (75 años y más): resultados de una serie consecutiva ambulatoria de 736 pacientes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Pérez-Martínez" 1 => "A. Puente-Muñoz" 2 => "B. Anciones" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Neurologia" "fecha" => "2008" "volumen" => "23" "paginaInicial" => "436" "paginaFinal" => "440" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18726721" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Headache in the elderly: primary forms" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.C. Tonini" 1 => "G. Bussone" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10072-010-0278-5" "Revista" => array:7 [ "tituloSerie" => "Neurol Sci" "fecha" => "2010" "volumen" => "31" "numero" => "Suppl. 1" "paginaInicial" => "S67" "paginaFinal" => "S71" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20464587" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Secondary headaches in the elderly" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Tanganelli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10072-010-0277-6" "Revista" => array:7 [ "tituloSerie" => "Neurol Sci" "fecha" => "2010" "volumen" => "31" "numero" => "Suppl. 1" "paginaInicial" => "S73" "paginaFinal" => "S76" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20464588" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of headache" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.C. Manzoni" 1 => "L.J. Stovner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Hand Clin Neurol" "fecha" => "2011" "volumen" => "97" "paginaInicial" => "1" "paginaFinal" => "22" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevention and management of medication overuse headache" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.B. Russell" 1 => "C. Lundqvist" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/WCO.0b013e328352c431" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Neurol" "fecha" => "2012" "volumen" => "25" "paginaInicial" => "290" "paginaFinal" => "295" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22547100" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical features, pathophysiology, and treatment of medication-overuse headache" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Evers" 1 => "M. Marziniak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1474-4422(10)70008-9" "Revista" => array:6 [ "tituloSerie" => "Lancet Neurol" "fecha" => "2010" "volumen" => "9" "paginaInicial" => "391" "paginaFinal" => "401" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20298963" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Giant cell arteritis: a review of classification, pathophysiology, geoepidemiology and treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.T. Borchers" 1 => "M.E. Gershwin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.autrev.2012.01.003" "Revista" => array:6 [ "tituloSerie" => "Autoimmun Rev" "fecha" => "2012" "volumen" => "11" "paginaInicial" => "A544" "paginaFinal" => "A554" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22285588" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Demographics of headache in elderly patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.D. Solomon" 1 => "R.S. Kunkel" 2 => "J. Frame" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Headache" "fecha" => "1990" "volumen" => "30" "paginaInicial" => "273" "paginaFinal" => "276" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2354949" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Headache in giant cell arteritis and other arteritides" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.N. Ward" 1 => "M. Levin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10072-005-0426-5" "Revista" => array:7 [ "tituloSerie" => "Neurol Sci" "fecha" => "2005" "volumen" => "26" "numero" => "Suppl. 2" "paginaInicial" => "S134" "paginaFinal" => "S137" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15926011" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Giant cell arteritis epidemiology, etiology and pathogenesis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Nordborg" 1 => "E. Nordborg" 2 => "V. Petursdottir" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Acta Pathol Microbiol Immunol Scand" "fecha" => "2000" "volumen" => "108" "paginaInicial" => "713" "paginaFinal" => "724" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of giant cell arteritis and polymyalgia rheumatica" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Gonzalez-Gay" 1 => "T.R. Vazquez-Rodriguez" 2 => "M.J. Lopez-Diaz" 3 => "J.A. Miranda-Filloy" 4 => "C. González-Juanetey" 5 => "J. Martin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.24459" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2009" "volumen" => "61" "paginaInicial" => "1454" "paginaFinal" => "1461" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19790127" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fisiopatología, métodos diagnósticos, criterios de derivación y criterios de hospitalización" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Sánchez del Río" 1 => "A.B. Caminero" 2 => "J. Escudero" 3 => "P. Irimia" 4 => "P. Pozo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Guía oficial para el diagnóstico y tratamiento de las cefaleas 2011" "paginaInicial" => "19" "paginaFinal" => "41" "serieFecha" => "2011" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of primary headaches and cranial neuralgias in men and women aged 55–94 years (Bruneck Study)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Schwaiger" 1 => "S. Kiechl" 2 => "K. Seppi" 3 => "M. Sawires" 4 => "H. Stockner" 5 => "T. Erlacher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-2982.2008.01705.x" "Revista" => array:6 [ "tituloSerie" => "Cephalalgia" "fecha" => "2009" "volumen" => "29" "paginaInicial" => "179" "paginaFinal" => "187" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18823362" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tension-type headache in the elderly" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.C. Crystal" 1 => "B.M. Grosberg" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Curr Pain Headache Rep" "fecha" => "2009" "volumen" => "13" "paginaInicial" => "474" "paginaFinal" => "478" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19889290" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tension-type headache in the elderly" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.G. Kaniecki" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Curr Treat Options Neurol" "fecha" => "2007" "volumen" => "9" "paginaInicial" => "31" "paginaFinal" => "37" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17288887" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of primary headaches in Germany: results of the German Headache Consortium Study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.S. Yoon" 1 => "Z. Katsarava" 2 => "M. Obermann" 3 => "G. Fritsche" 4 => "M. Oezyurt" 5 => "K. Kaesewinkel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10194-012-0425-x" "Revista" => array:6 [ "tituloSerie" => "J Headache Pain" "fecha" => "2012" "volumen" => "13" "paginaInicial" => "215" "paginaFinal" => "223" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22395638" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Headache Classification Committee New appendix criteria open for a broader concept of chronic migraine" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Olesen" 1 => "M.J. Bousser" 2 => "H.C. Diener" 3 => "D. Dodick" 4 => "M. First" 5 => "P.J. Goadsby" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-2982.2006.01172.x" "Revista" => array:6 [ "tituloSerie" => "Cephalalgia" "fecha" => "2006" "volumen" => "26" "paginaInicial" => "742" "paginaFinal" => "746" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16686915" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Migraine throughout the life cycle: treatment through the ages" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S. Landy" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Neurology" "fecha" => "2004" "volumen" => "62" "numero" => "5 Suppl. 2" "paginaInicial" => "S2" "paginaFinal" => "S8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15037671" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic migraine prevalence, disability, and sociodemographic factors: results from the American Migraine Prevalence and Prevention Study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.C. Buse" 1 => "A.N. Manack" 2 => "K.M. Fanning" 3 => "D. Serrano" 4 => "M.L. Reed" 5 => "C.C. Turkel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1526-4610.2012.02223.x" "Revista" => array:6 [ "tituloSerie" => "Headache" "fecha" => "2012" "volumen" => "52" "paginaInicial" => "1456" "paginaFinal" => "1470" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22830411" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unusual headaches in the elderly" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.C. Bamford" 1 => "M. Mays" 2 => "S.J. Tepper" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11916-011-0196-0" "Revista" => array:6 [ "tituloSerie" => "Curr Pain Headache Rep" "fecha" => "2011" "volumen" => "15" "paginaInicial" => "295" "paginaFinal" => "301" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21455737" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Migraine and stroke: a complex association with clinical implications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T. Kurth" 1 => "H. Chabriat" 2 => "M.G. Bousser" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1474-4422(11)70266-6" "Revista" => array:6 [ "tituloSerie" => "Lancet Neurol" "fecha" => "2012" "volumen" => "11" "paginaInicial" => "92" "paginaFinal" => "100" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22172624" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of headache in the elderly" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.S. Robbins" 1 => "R.B. Lipton" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2165/11315980-000000000-00000" "Revista" => array:6 [ "tituloSerie" => "Drugs Aging" "fecha" => "2010" "volumen" => "27" "paginaInicial" => "377" "paginaFinal" => "398" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20450236" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cefalea hípnica: características de una serie de 13 nuevos casos y propuesta de modificación de los criterios diagnósticos" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Mulero" 1 => "A.L. Guerrero-Peral" 2 => "E. Cortijo" 3 => "N.S. Jabary" 4 => "S. Herrero-Velázquez" 5 => "S. Miranda" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Neurol" "fecha" => "2012" "volumen" => "54" "paginaInicial" => "129" "paginaFinal" => "136" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22278889" "web" => "Medline" ] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0205" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "SUNCT and SUNA: clinical features and medical treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.H. Williams" 1 => "S.A. Broadley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jocn.2006.09.006" "Revista" => array:6 [ "tituloSerie" => "J Clin Neurosci" "fecha" => "2008" "volumen" => "15" "paginaInicial" => "526" "paginaFinal" => "534" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18325769" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack87456" "titulo" => "Acknowledgements" "texto" => "<p id="par0170" class="elsevierStylePara elsevierViewall">Many thanks again to Lourdes; without your dedicated efforts in the headache unit, none of this would have been possible.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735808/0000002900000006/v1_201407240029/S2173580814000868/v1_201407240029/en/main.assets" "Apartado" => array:4 [ "identificador" => "17109" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "CO1" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735808/0000002900000006/v1_201407240029/S2173580814000868/v1_201407240029/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580814000868?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 1 | 7 |
| 2024 October | 31 | 6 | 37 |
| 2024 September | 47 | 7 | 54 |
| 2024 August | 44 | 14 | 58 |
| 2024 July | 36 | 4 | 40 |
| 2024 June | 22 | 4 | 26 |
| 2024 May | 34 | 10 | 44 |
| 2024 April | 34 | 5 | 39 |
| 2024 March | 44 | 9 | 53 |
| 2024 February | 54 | 12 | 66 |
| 2024 January | 51 | 8 | 59 |
| 2023 December | 69 | 6 | 75 |
| 2023 November | 68 | 16 | 84 |
| 2023 October | 80 | 18 | 98 |
| 2023 September | 47 | 4 | 51 |
| 2023 August | 34 | 7 | 41 |
| 2023 July | 34 | 11 | 45 |
| 2023 June | 57 | 12 | 69 |
| 2023 May | 77 | 5 | 82 |
| 2023 April | 35 | 4 | 39 |
| 2023 March | 48 | 4 | 52 |
| 2023 February | 42 | 10 | 52 |
| 2023 January | 48 | 4 | 52 |
| 2022 December | 43 | 5 | 48 |
| 2022 November | 50 | 10 | 60 |
| 2022 October | 45 | 22 | 67 |
| 2022 September | 22 | 14 | 36 |
| 2022 August | 38 | 13 | 51 |
| 2022 July | 28 | 19 | 47 |
| 2022 June | 27 | 5 | 32 |
| 2022 May | 36 | 9 | 45 |
| 2022 April | 46 | 19 | 65 |
| 2022 March | 52 | 15 | 67 |
| 2022 February | 57 | 7 | 64 |
| 2022 January | 82 | 9 | 91 |
| 2021 December | 51 | 16 | 67 |
| 2021 November | 55 | 11 | 66 |
| 2021 October | 39 | 9 | 48 |
| 2021 September | 50 | 23 | 73 |
| 2021 August | 130 | 10 | 140 |
| 2021 July | 37 | 18 | 55 |
| 2021 June | 33 | 22 | 55 |
| 2021 May | 72 | 11 | 83 |
| 2021 April | 149 | 40 | 189 |
| 2021 March | 63 | 14 | 77 |
| 2021 February | 82 | 23 | 105 |
| 2021 January | 88 | 22 | 110 |
| 2020 December | 61 | 11 | 72 |
| 2020 November | 55 | 17 | 72 |
| 2020 October | 45 | 8 | 53 |
| 2020 September | 46 | 9 | 55 |
| 2020 August | 45 | 9 | 54 |
| 2020 July | 24 | 5 | 29 |
| 2020 June | 26 | 20 | 46 |
| 2020 May | 31 | 14 | 45 |
| 2020 April | 49 | 10 | 59 |
| 2020 March | 33 | 8 | 41 |
| 2020 February | 61 | 14 | 75 |
| 2020 January | 41 | 11 | 52 |
| 2019 December | 36 | 15 | 51 |
| 2019 November | 15 | 5 | 20 |
| 2019 October | 34 | 3 | 37 |
| 2019 September | 40 | 17 | 57 |
| 2019 August | 19 | 5 | 24 |
| 2019 July | 35 | 9 | 44 |
| 2019 June | 62 | 18 | 80 |
| 2019 May | 131 | 30 | 161 |
| 2019 April | 87 | 3 | 90 |
| 2019 March | 19 | 15 | 34 |
| 2019 February | 17 | 13 | 30 |
| 2019 January | 11 | 7 | 18 |
| 2018 December | 4 | 5 | 9 |
| 2018 November | 17 | 9 | 26 |
| 2018 October | 22 | 17 | 39 |
| 2018 September | 31 | 7 | 38 |
| 2018 August | 14 | 3 | 17 |
| 2018 July | 15 | 3 | 18 |
| 2018 June | 10 | 5 | 15 |
| 2018 May | 9 | 7 | 16 |
| 2018 April | 4 | 2 | 6 |
| 2018 March | 6 | 3 | 9 |
| 2018 February | 10 | 4 | 14 |
| 2018 January | 4 | 7 | 11 |
| 2017 December | 3 | 3 | 6 |
| 2017 November | 13 | 2 | 15 |
| 2017 October | 9 | 7 | 16 |
| 2017 September | 14 | 6 | 20 |
| 2017 August | 20 | 5 | 25 |
| 2017 July | 27 | 3 | 30 |
| 2017 June | 22 | 7 | 29 |
| 2017 May | 20 | 7 | 27 |
| 2017 April | 19 | 4 | 23 |
| 2017 March | 17 | 6 | 23 |
| 2017 February | 16 | 7 | 23 |
| 2017 January | 26 | 6 | 32 |
| 2016 December | 28 | 9 | 37 |
| 2016 November | 29 | 8 | 37 |
| 2016 October | 46 | 13 | 59 |
| 2016 September | 79 | 30 | 109 |
| 2016 August | 34 | 10 | 44 |
| 2016 July | 18 | 4 | 22 |
| 2016 June | 32 | 16 | 48 |
| 2016 May | 34 | 20 | 54 |
| 2016 April | 17 | 15 | 32 |
| 2016 March | 32 | 20 | 52 |
| 2016 February | 22 | 17 | 39 |
| 2016 January | 24 | 8 | 32 |
| 2015 December | 27 | 12 | 39 |
| 2015 November | 29 | 5 | 34 |
| 2015 October | 21 | 10 | 31 |
| 2015 September | 33 | 6 | 39 |
| 2015 August | 23 | 13 | 36 |
| 2015 July | 19 | 8 | 27 |
| 2015 June | 24 | 10 | 34 |
| 2015 May | 25 | 5 | 30 |
| 2015 April | 31 | 18 | 49 |
| 2015 March | 26 | 15 | 41 |
| 2015 February | 34 | 6 | 40 |
| 2015 January | 46 | 11 | 57 |
| 2014 December | 51 | 15 | 66 |
| 2014 November | 40 | 13 | 53 |
| 2014 October | 34 | 25 | 59 |
| 2014 September | 63 | 34 | 97 |
| 2014 August | 74 | 37 | 111 |
| 2014 July | 8 | 5 | 13 |
Show all
