The prevalence of headache in persons aged 50 years and older ranges from 12% to 50%.1,2 Although headaches are generally less likely to occur in older patients compared with younger patients, they remain a serious issue.
Headache in older adults is typically caused by a primary headache disorder, such as tension-type headache, migraine headache, or cluster headache, with each primary headache disorder having varying prevalence rates in the different age groups.1,3 Tension-type headache is the most common primary headache disorder, followed by migraine, in both older and younger patients.1
Further, increased comorbid conditions in advancing age leads to an increased risk of secondary causes of headache in the older population, such as cerebrovascular ischemic events, intracranial hemorrhage, cerebral neoplasm, giant cell arteritis, head trauma, and medication overuse headache, to name a few.1 Patients aged 65 years and older have a 10-fold increased risk of secondary headache, which can be life-threatening.2
Clinicians should therefore rule out potential secondary headache disorders in their older patients presenting with new-onset headache by obtaining a detailed clinical history and performing a comprehensive neurologic examination and diagnostic evaluation that includes blood tests and neuroimaging. A primary headache disorder should be considered after a secondary headache disorder has been ruled out.1
Managing primary and secondary headaches in older patients is often challenging, and treatment options may be limited and may need to be tailored due to factors such as comorbidities, drug-drug interactions, polypharmacy, physiologic changes, and altered pharmacokinetics.1
1. Starling AJ. Diagnosis and management of headache in older adults. Mayo Clin Proc. 2018;93(2):252-262.
2. Pascual J, Berciano J. Experience in the diagnosis of headaches that start in elderly people. J Neurol Neurosurg Psychiatry. 1994;57(10):1255-1257.
3. Song TJ, Kim YJ, Kim BK, et al. Characteristics of elderly-onset (≥65 years) headache diagnosed using the International Classification of Headache Disorders, third edition beta version. J Clin Neurol. 2016;12(4):419-425.
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