高齡族的頭痛
楊惟婷整理
年輕時常出現的偏頭痛和其他原發性頭痛，可能隨著年齡增加而日趨緩和。不過對老年人而言，該注意的是次發性頭痛，因為可能是罹患其他疾病引起的頭痛。
一、原發性頭痛引起
1、偏頭痛
很多有偏頭痛的人到了40幾歲，頭痛發作的頻率開始降低。只有2％的成人到50歲後，才開始發生偏頭痛。
但此類型偏頭痛事先多有預兆，不過如果頭痛預兆出現，卻沒頭痛症狀，則千萬不能大意，因為預兆很可能來自其他疾病，尤其是暫時性腦缺血，可能是腦中風的警訊，必須由醫生評估。
2、緊縮型頭痛
緊縮型頭痛是老人最常見的頭痛。有10％的老人在50歲後，首度嘗到緊縮型頭痛，發作時額頭像被帶子緊緊勒住，持續幾小時或幾天。
如果頭痛一個星期發作好幾次，就可能和過度用藥，而導致反彈性頭痛有關。
3、睡眠頭痛
睡眠頭痛幾乎是唯一只發生於老年人的原發性頭痛。大部份患者是在65～85歲之間，首度經歷睡眠頭痛。
睡眠頭痛發生在晚上，讓人頭痛到醒過來。通常每晚同樣時間發作，從中度到重度抽痛，每次時間從15分鐘到1、2小時。
顱動脈炎、睡眠呼吸中止症、腦瘤和硬膜下血腫症狀，常造成夜間頭痛，很容易和睡眠疼痛混淆，因此必須先將次發性頭痛的原因排除。
睡前來一點咖啡因可能預防頭痛發作。
二、其他疾病引起的次發性頭痛
50歲以上的人，原發性頭痛比率降低，但次發性頭痛的比率則增加。
一旦過了65歲，因為嚴重次發性疾病導致頭痛的危險性增加10倍。
50歲後，頭痛可能來自於常見的疾病。這些疾病包括：
1、腦血管疾病
隨著年紀增長，發生血管狹窄、阻塞、發炎或受傷，以至於阻礙血液流到腦部的危險性也隨之增加。血流長時間受阻，可能造成致命的威脅。
■高血壓：
高血壓初期，頭的後部可能發生鈍痛，但大部份要一直到很危險的地步，可能損壞血管或重要器官時，才會出現頭痛。隨著年齡增加等因素，危險性也會提高。
■暫時性腦缺血發作和腦中風：
也稱為小中風或中風預警，暫時阻礙流往腦部的血流，增加中風的危險性。這類型疾病造成頭痛發作時，可能伴隨手腳無力、麻痺或刺痛、言語困難、視力減退或喪失，及失去平衡或協調。
■顱動脈炎：
也稱為巨細胞動脈炎或顳動脈炎，好發於老人，平均70歲開始發作。動脈發炎導致頭抽痛、頭皮痛與頜疼痛。眼睛和腦部的血流少，可能造成失明或腦中風等併發症。
2、顱內異常
腦瘤是相當罕見的頭痛原因，但這些異常細胞簇（cellclusters）的形成，在老年更常見，並且可能製造更嚴重的頭痛。事實上，頭痛通常是腦瘤形成的第一個跡象，伴隨嘔吐、視力模糊、言語困難等其他症狀。
而平穩或波動不定的頭痛，可能是硬膜下血腫造成，這也可能增加腦部壓力。這種情況較可能發生在與年長有關的腦萎縮。
3、神經痛
三叉神經痛主要發生在50歲以後。突然發生臉部灼燒般疼痛，可能持續幾秒到約一分鐘。
帶狀疹後神經痛是由於過去的水痘病毒，在神經細胞內再度受到活化而引起。
在帶狀疹的紅疹痊癒很久後，受影響的部位如臉部，仍會有尖銳、灼燒般的劇痛。年長者比較容易罹患。
4、眼、頷、頸與頜的情況與代謝異常
持續的鈍痛，特別是在頭部後面，可能是頸椎關節沾黏。這是頸部軟骨和骨頭異常磨損，及神經根受壓迫所造成的異常狀況。
青光眼患者大部份年過50，會造成眼球內部壓力增加，損壞視神經。急性隅角閉鎖性青光眼通常是指一隻眼睛突然劇痛，可能演變成廣泛性頭痛。
新陳代謝異常如甲狀腺機能亢進和減退，可能導致體內荷爾蒙失去平衡，造成疲倦、四肢無力、噁心和頭痛。
5、藥物副作用與藥物濫用
包括高血壓、心臟病、肺氣腫、潰瘍、巴金森症和停經藥物常發生頭痛的副作用。止痛和治鼻塞成藥也可能造成慢性頭痛。
三、頭痛治療
如果你在50歲以後，出現不曾有過的頭痛，最好去看醫生，找出紓解或預防頭痛的方式。
如果你偶然有偏頭痛或緊縮型頭痛，最好在頭痛剛出現時吃止痛藥。但如果頭痛愈來愈頻繁，可得注意，因為可能會出現與年紀、整體健康狀況有關的潛在併發症。
不過須注意，過度使用成藥，可能引起噁心、胃痛、胃出血或潰瘍，尤其是對老年人。合併乙醯胺酚與較強的巴比妥酸鹽或鴉片劑的止痛劑，與反彈性頭痛有密切關連。
特別研發用於緩和偏頭痛或其他慢性頭痛的處方藥，以及用於紓解偏頭痛和叢發性頭痛的皮質類固醇，可能不適用於老年人。醫師可以低劑量的止痛藥結合放鬆療法等非藥物療法，來減輕病患頭痛。
最近幾年，按摩、針灸等非藥物療法大受歡迎，用來輔助傳統頭痛治療。可和醫生商量，找出最適合你的年紀與最有益於你的治療之道。
四、提神醒腦穴道按摩
以下教大家幾個提神穴道方法，可幫助你上班更清醒～
按摩穴位好提神方法
1、太陽穴：輕按或輕揉即可，不可用力過度。
2、百會穴：輕按、輕揉有些微痠脹感即可。
3、風池穴：雙手輕抓住頭部，兩隻大拇指揉穴位，可感覺到明顯痠脹感。
4、足三里穴：按摩力道可稍大，一樣會有痠脹感。
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