From the Guidelines
Headaches do not typically increase with age for most people. In fact, many primary headache disorders like migraines often decrease in frequency and severity as people get older, particularly after age 50, as noted in a 2021 study on the diagnosis and management of migraine 1. However, aging can bring new headache triggers and types, such as those related to medication overuse, sleep disturbances, or secondary headaches from age-related conditions. For older adults experiencing new or changing headache patterns, it's essential to consult a healthcare provider as these could signal underlying health issues. Management typically involves identifying triggers, maintaining healthy lifestyle habits, and appropriate medication when needed. Some key points to consider include:
- Migraine often remits with older age, whereas the incidence of many secondary headaches increases 1
- Onset of apparent migraine after the age of 50 years should arouse suspicion of an underlying condition 1
- Aging itself doesn't necessarily mean more headaches, but the changing physiology and health conditions that accompany aging can alter headache patterns and require different approaches to treatment. As people age, it's crucial to be aware of these potential changes and to seek medical attention if headaches persist, worsen, or are accompanied by other concerning symptoms.
From the Research
Prevalence of Headaches with Age
- The prevalence of headaches declines with age, but they remain a common neurologic complaint among elderly populations 2.
- Headaches can be divided into primary and secondary causes, with primary headaches comprising about two-thirds of headaches among the elderly 2.
Primary Headaches in the Elderly
- Primary headaches include migraine, tension-type, trigeminal autonomic cephalalgias, and hypnic headache 2.
- Migraine and tension-type headaches are rarely new onset in older adults and should be a diagnosis of exclusion 3.
- In older individuals, migraine is more likely to be bilateral with less sensory sensitivities 3.
Secondary Headaches in the Elderly
- Secondary headaches become more common among older patients 3.
- A higher index of suspicion for a secondary headache disorder is warranted in older patients with new-onset headache, as they are roughly 12 times more likely to have serious underlying causes 2.
- Secondary causes of headaches in the elderly include giant cell arteritis, intracranial mass lesions, ischemic cerebrovascular disease, and chronic obstructive lung disease with hypercapnia 4.
- Other secondary causes discussed include temporal or giant cell arteritis, subdural hematomas, central nervous system (CNS) tumors, strokes, and CNS infections 5.
Diagnosis and Management
- Diagnosis and management of headaches in older adults can be challenging due to the presence of multiple medical comorbidities, polypharmacy, and differences in drug metabolism and clearance 2.
- A focused diagnostic evaluation is recommended, ranging from blood tests to neuroimaging, depending on the headache characteristics 6.
- Treatment options may be limited in older patients and may need to be tailored to the presence of comorbid medical conditions 6.