Headaches often become less frequent with age, but some may signal another issue. Learn which symptoms are typical and when to consult your doctor.
Written by Randolph W. Evans | Medically Reviewed by Sabrina Felson, MD
Older people have fewer headaches than younger ones, and women have more headaches than men throughout their lives. For example, between ages 21 and 34, the prevalence of headaches is 92% in women and 74% in men; after age 75, the prevalence drops to 55% and 21%, respectively.
Migraines tend to disappear with age, too. At age 70, only 10% of women and 5% of men experience them.
But some headaches in older age can indicate a much more serious medical condition.
Late-Life Migraine Associated Symptoms
Late-life migraine-associated symptoms are defined as passing neurological symptoms that can affect vision, speech, movement, and behavior. They are similar or identical to migraine “aura,” the symptoms that precede a migraine. However, headache is associated with only 50% of cases and may be mild.
Migraine accompaniments may consist of visual symptoms such as transient blindness, homonymous hemianopsia (loss of vision on one side of one’s visual field), and blurring of vision; paresthesias (numbness, tingling, pins-and-needles sensation), a heavy feeling in an extremity like an arm or leg; brain stem and cerebellar dysfunction such as ataxia (clumsiness), hearing loss, tinnitus (ringing in ears), vertigo (sense of room spinning), syncope (loss of consciousness); and disturbances of speech, such as dysarthria (slurred speech) or aphasia (loss of ability to speak). They may come in succession.
Cerebrovascular Disease
Headaches commonly accompany stroke. In a study of 163 patients who’d had a stroke, 60% reported a headache with the stroke, especially women and those with a history of headaches. Up to 46% reported having an incapacitating headache; most said the headache was mild to moderately painful. The headaches are equally likely to come on quickly or slowly.
A type of stroke called a subarachnoid hemorrhage usually feels like the worst headache of your life — and may have no other symptoms than the headache.
Head Trauma
Although there are many causes of head trauma, falling is a particular problem. Approximately 30% of people ages 65 and older fall at least once a year. If the person has dementia, they might not remember having fallen.
Subdural hematomas, or bleeding on the brain, can result from a mild head injury. These brain traumas can be life-threatening and may leave mild behavioral or other chronic dysfunction.
Headaches are present in up to 90% of patients with head trauma, including subdural hematomas. The headaches can range from mild to severe, can be intermittent or constant, and can happen on one or both sides of the head. Coughing, straining, or exercise can make them worse, and sometimes there’s vomiting and nausea.
Temporal Arteritis
Headaches are the most common symptom of temporal (giant cell) arteritis, or TA, a disease that causes your arteries — blood vessels that carry oxygen from your heart to the rest of your body — to swell and narrow. It usually happens to the large and medium-sized temporal arteries that run along both sides of your head. The cells of these inflamed arteries look huge under a microscope; hence, the condition’s name.
Postherpetic Neuralgia
Postherpetic neuralgia is nerve pain that lingers after an outbreak of shingles, a rash also known as herpes zoster that may also affect the face. Shingles has the same origin as chickenpox, caused as it is by the varicella virus. It is characterized by sores that form and crust over 3 to 4 weeks. It can cause nerve damage that leads to burning, shooting, and tingling pain for 3 months or longer (called postherpetic neuralgia).
The persistence of pain from shingles is more common among people older than age 80. Shingles that involve the face nearly doubles the risk of developing facial postherpetic neuralgia.
Treatment includes anticonvulsants, antidepressants, aspirin, NSAIDs, and creams.
TA is more common in people older than age 50. The headache pain is described most often as throbbing and may be intermittent or constant. The headache can be on one or both sides of the head, typically near the temples. But it can be over the forehead or even the back of the head. About half of the people with TA also get bad pain in the jaw with chewing.
Trigeminal Neuralgia
When there is pressure on the trigeminal nerve, which controls facial feeling, it can cause excruciating pain in the lower part of the face, around the nose, and above the eye. The neuralgia, or nerve pain, can be triggered by doing ordinary things – brushing your teeth, chewing, or blowing your nose. In a small number of cases, the pain is caused by a tumor pressing on the trigeminal nerve.
The condition is more common in people older than age 50 and is seen more in women than men. It may run in families. Risk factors include hypertension and multiple sclerosis.
Hypnic Headache
Hypnic headache is a rare disorder that occurs in men and women aged 40 to 79. The headache occurs only during sleep and awakens a person at a consistent time. The headache can be on one or both sides of the head, can throb or not, and can range from mild to severe. They typically last for 2-3 hours (but can last up to 6 hours), and they can happen nightly for years.