Headaches in people over the age of 65 require a higher level of caution than in younger individuals. This is because headaches in this age group are more frequently caused by serious underlying conditions requiring immediate medical attention. While primary headaches like migraines and tension headaches become less common with advanced age, the risk of a secondary headache—one caused by another illness—increases significantly. Any new headache experience in an older adult should prompt a thorough investigation to rule out potentially life-threatening causes.
Critical Warning Signs in Older Adults
The assessment of a headache in an older adult begins by looking for distinct “red flag” symptoms. A headache described as the “worst headache of life” that reaches maximum intensity within seconds or minutes (a thunderclap headache) requires immediate medical evaluation. Any new type of headache pain that differs from previous patterns is a significant concern, especially if it begins after age 50. This change could involve a different location, quality of pain, or a sudden increase in frequency.
Headaches accompanied by systemic symptoms, such as unexplained fever, night sweats, or unintentional weight loss, can indicate a serious infection or inflammatory process. Neurological changes are another warning sign, including new-onset confusion, difficulty walking, slurred speech, or weakness on one side of the body.
Pain made worse by physical exertion, coughing, or bending over suggests that the pressure inside the skull may be elevated. Additionally, any new headache associated with tenderness in the temple area or vision changes demands urgent assessment. These indicators signal conditions that can cause rapid disability if treatment is delayed.
Serious Vascular and Structural Causes
One age-specific and dangerous cause of a new headache is Giant Cell Arteritis (GCA), also known as temporal arteritis. This condition involves the inflammation of medium-to-large blood vessels, typically affecting the arteries in the head near the temples. The headache is often severe, persistent, and localized, sometimes accompanied by scalp tenderness that makes combing hair painful.
A specific symptom of GCA is jaw claudication, which is pain in the jaw muscles while chewing due to restricted blood flow. GCA can lead to sudden, irreversible vision loss if inflammation affects the arteries supplying the optic nerve. Prompt diagnosis and immediate high-dose steroid treatment are necessary to prevent blindness.
Another serious structural cause is a Subdural Hematoma (SDH), a collection of blood between the brain and its outer covering. Older adults are at higher risk because age-related brain shrinkage stretches the bridging veins, making them susceptible to tearing from minor trauma. Symptoms can be subtle and delayed, presenting as a chronic headache, confusion, or gradual changes in mental status often mistaken for dementia.
Vascular events, such as a stroke or a transient ischemic attack (TIA), can present with a severe headache. A stroke occurs when blood flow to a part of the brain is interrupted, and the headache can be a direct symptom. Infections like meningitis, an inflammation of the membranes surrounding the brain and spinal cord, also cause headaches, often accompanied by a stiff neck and high fever.
Headaches Related to Medications and Chronic Conditions
Many chronic headaches in the elderly are linked to ongoing health issues and their management. Medication Overuse Headaches (MOH), sometimes called rebound headaches, are common in older adults who frequently use pain relievers for chronic conditions. This headache type occurs when the body becomes dependent on the medication, causing the pain to return as the drug wears off and leading to a cycle of increased use.
Chronic health conditions also contribute to headache frequency and severity. Uncontrolled high blood pressure (hypertension) may cause a headache, especially when severely elevated. Dehydration, common in older adults due to reduced thirst sensation, can also trigger a dull, persistent headache that resolves with fluid replacement.
Age-related degenerative changes in the neck, such as cervical spine osteoarthritis, can lead to cervicogenic headaches. These originate from neck structures, often causing pain that radiates from the back of the head up to the forehead or temples. They are associated with reduced neck mobility and tenderness in the neck muscles. Acute angle-closure glaucoma, involving a sudden rise in eye pressure, is another cause of severe, often unilateral, head pain requiring urgent eye care.
Seeking Urgent Medical Evaluation
Any new or significantly changed headache in an older adult should be evaluated by a healthcare provider without delay. Immediate emergency services should be contacted if the headache is the “worst ever,” is accompanied by sudden loss of consciousness, or includes new neurological symptoms like difficulty speaking or walking. These signs point to an acute event requiring immediate diagnostic imaging, such as a CT scan or MRI.
For non-emergency situations, provide a complete medication list, including all supplements and over-the-counter pain relievers, to assess for Medication Overuse Headache or drug interactions. Reporting the precise onset, location, and character of the headache is also important for diagnosis. The presence of warning signs should prompt the healthcare provider to perform an aggressive diagnostic workup to identify the underlying secondary cause quickly.