Differential Diagnosis for Headaches in a 60-Year-Old
Single Most Likely Diagnosis
- Tension Headache: The most common type of headache, often described as a band or a squeezing sensation around the forehead, back of the neck, or both. It's more prevalent with age and can be exacerbated by stress, poor posture, or other factors common in the elderly.
Other Likely Diagnoses
- Migraine: Although migraines are more common in younger populations, they can persist into older age. They are characterized by severe, unilateral headaches often accompanied by nausea, vomiting, and sensitivity to light or sound.
- Cervicogenic Headache: Arising from the cervical spine, these headaches are more common in older adults due to degenerative changes in the neck. They are typically unilateral and can be accompanied by neck pain or stiffness.
- Medication Overuse Headache: Given the higher likelihood of chronic medication use in older adults, medication overuse headaches are a consideration. These occur when frequent or excessive use of headache medications leads to worsening headache frequency or intensity.
Do Not Miss Diagnoses
- Giant Cell Arteritis (Temporal Arteritis): A condition that can lead to blindness if not promptly treated. It typically presents with unilateral headache, scalp tenderness, jaw claudication, and visual disturbances in individuals over 50 years old.
- Subarachnoid Hemorrhage: Although less common, this condition is a medical emergency. It presents with a sudden, severe headache (often described as "the worst headache of my life"), which can be accompanied by nausea, vomiting, and loss of consciousness.
- Brain Tumor: While rare, brain tumors can cause headaches, especially if they increase intracranial pressure. The headaches are often worse in the morning and can be accompanied by neurological deficits.
- Stroke or Transient Ischemic Attack (TIA): Headache can be a feature of stroke or TIA, particularly if it's a hemorrhagic stroke. Sudden onset of headache with focal neurological deficits warrants immediate medical attention.
Rare Diagnoses
- Trigeminal Neuralgia: Characterized by sudden, severe, shock-like pain around the eyes, lips, or nose, typically on one side of the face. It's more common in older adults but is relatively rare.
- Idiopathic Intracranial Hypertension (IIH): Also known as pseudotumor cerebri, this condition is characterized by increased intracranial pressure without a detectable cause. It's rare and more commonly seen in younger, obese women but can occur in any demographic.
- Hypnic Headache: A rare condition that occurs exclusively during sleep, typically in older adults. The headaches are usually bilateral and can be accompanied by nausea and vomiting.