Differential Diagnosis for New Onset Headache in Patients Over 50
Single Most Likely Diagnosis
- Tension Headache: This is the most common type of headache and can occur at any age, including over 50. It's often described as a band or a squeezing sensation around the forehead, back of the neck, or both, and can be related to stress, poor posture, or other factors.
Other Likely Diagnoses
- Migraine: Although migraines often start at a younger age, they can begin for the first time in people over 50. They are characterized by severe, throbbing headaches, often on one side of the head, and can be accompanied by nausea, vomiting, and sensitivity to light and sound.
- Cervicogenic Headache: These headaches are caused by referred pain from the cervical spine and are more common in older adults due to degenerative changes in the neck. They typically occur on one side of the head and can be accompanied by neck pain and stiffness.
- Medication Overuse Headache: Also known as rebound headache, this condition occurs when frequent or excessive use of headache medications leads to worsening of headache frequency and intensity. It's a common issue in older adults who may have been managing headaches for years.
Do Not Miss Diagnoses
- Giant Cell Arteritis (Temporal Arteritis): This is an inflammatory condition affecting the blood vessels, particularly those in the head. It's a medical emergency because it can lead to blindness if not promptly treated. Symptoms include severe headache, scalp tenderness, jaw claudication, and visual disturbances.
- Subarachnoid Hemorrhage: Although less common, a new onset headache in someone over 50 could be a sign of a subarachnoid hemorrhage, which is bleeding into the space surrounding the brain. This condition often presents with a sudden, severe headache (often described as "the worst headache of my life") and can be accompanied by vomiting, seizures, and loss of consciousness.
- Brain Tumor: A new onset headache, especially if it's worsening over time, could be a sign of a brain tumor. Other symptoms might include seizures, confusion, memory loss, and focal neurological deficits.
- Stroke or Transient Ischemic Attack (TIA): While not typically presenting solely as a headache, in some cases, a stroke or TIA can cause a sudden, severe headache. Other symptoms might include sudden weakness, numbness, vision changes, speech difficulties, and dizziness.
Rare Diagnoses
- Trigeminal Neuralgia: This condition involves sudden, severe, shock-like pain around the eyes, lips, or nose mainly because of abnormal blood vessels pressing on the trigeminal nerve in the head. 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 pressure within the skull without any apparent cause. Symptoms include headache, vision changes (such as double vision), and tinnitus. It's rare and more commonly seen in younger, obese women but can occur in anyone.
- Cranial Vasculitis: Inflammation of the blood vessels in the head can cause headaches and other neurological symptoms. This is a rare condition and often associated with systemic diseases or infections.