Headaches and older adults: What's common?

You've struggled with headaches for years. Is the end in sight?

Headaches have no age boundaries — but there's good news. Headaches typically become less frequent and less severe after age 50.

Expect headache patterns to change

Headache patterns often change as you get older. The specifics depend on the type of headache.

• Tension-type headaches. Tension-type headaches are the most common type of headache among older adults. In fact, 10 percent of adults experience a tension-type headache for the first time after age 50.

  Tension-type headaches are often described as a band of pressure tightening around your head. The pain may last for hours or days. Although tension-type headaches are often associated with the stress of work, school or parenting, other stresses — such as retirement, the loss of a loved one, an illness or another major life change — may trigger these headaches as well. Sometimes there's no apparent trigger.

• Migraine headaches. If you have migraines, you may enjoy a reprieve when you reach your 40s or 50s. At this age, the frequency and severity of migraine attacks often decline. Some older adults continue to experience auras — flashing lights, blind spots or other warning signs of an impending migraine attack — even without pain. If you haven't had a migraine by age 50, you're unlikely to ever experience one.
• Cluster headaches. Cluster headaches cause stabbing, boring or piercing pain in or around one eye or the temple. The pain usually lasts from 45 to 90 minutes. As the name implies, the headache attacks cluster together over a period of weeks. Cluster headaches are uncommon. If you haven't had a cluster headache by age 50, you're unlikely to ever experience one.
• Hypnic headaches. Hypnic headaches develop only during sleep, often waking you at the same time each night. The pain is usually moderate, lasting from less than 30 minutes to more than two hours. Hypnic headaches are uncommon and occur almost exclusively among older adults — often appearing for the first time after age 50.

Consider underlying causes

For older adults, up to one out of four or five headaches is actually a symptom of an underlying condition. Possible culprits include arthritis, sleep disturbances, and inflammation of the blood vessels around the brain and scalp (cranial arteritis). Less common — but more ominous — causes may include:

• Bleeding into the brain (cerebral hemorrhage)
• Bleeding on the surface of the brain (subdural hematoma)
• Temporary loss of blood flow to the brain (transient ischemic attack)
• Interrupted blood supply to part of the brain (stroke)

Some drugs taken for other conditions — particularly high blood pressure, heart disease, emphysema, ulcers, depression, Parkinson's disease and menopause — contribute to headaches. Even over-the-counter (OTC) medications such as pain relievers and decongestants can trigger headaches if you take them too often. These are known as rebound headaches.

Likewise, new health concerns may complicate existing headache treatments. As you get older, it becomes more difficult for your body to metabolize and eliminate medications. This may change the way you respond to your usual headache medication. And some pain relievers aren't safe to mix with other medications.

Treatment options may change, too

If you have an occasional migraine or tension-type headache, OTC pain relievers may improve or relieve the pain. But it's important to be cautious. OTC drugs such as aspirin, ibuprofen and naproxen can cause nausea, stomach pain, stomach bleeding or ulcers — particularly in older adults.

Prescription medications designed to treat migraines and other chronic headaches may cause other complications. Some of these medications work by constricting blood vessels. This can be dangerous if you have a medical condition that's already narrowing your blood vessels, such as high blood pressure or coronary artery disease.

But such restrictions don't mean you have to live in pain. If you have recurring headaches, lower doses of pain-relieving drugs can be combined with nondrug therapies such as stress management and relaxation therapy to control your pain.

Know when to consult your doctor

Most headaches are nothing to worry about. But it's important to let your doctor know what's going on. If you develop a new type of headache after age 50 or you notice changes in the pattern of headaches you've had for years, consult your doctor. He or she may identify an underlying cause and help you find the best way to treat — or prevent — the pain.

Sometimes a headache is a warning sign of something serious, such as bleeding in the brain or stroke. Seek emergency care if your headache:

• Is sudden and severe
• Accompanies a fever, stiff neck, rash, confusion, seizure, double vision, weakness, numbness or difficulty speaking
• Follows a head injury, fall or bump
• Gets worse despite rest and OTC pain medication

Prompt diagnosis and treatment can help prevent complications.