I frequently hear astonishment (and gratitude) in people’s voices when I tell them that headache specialists like me exist. But there is good reason for what we do. In fact, there are over 39 million headache sufferers in the United States and enough headache types to fill up giant textbooks — we’re talking more than 150 different headache types!
Headaches range from minor to excruciating, every once-in-a-while to daily, benign to life-threatening. They can involve pretty much any part of your head and face, involve no symptoms other than pain or even mimic a stroke (and everything in between). As a physician assistant who has worked in headache medicine for three years, I’ve pretty much seen them all.
Potential causes of your headaches
You can experience headaches at any age but for now, let’s talk about headaches after age 50. As we reach middle age, headaches tend to change or thankfully, reduce. Primary headaches remain the most common headaches. Primary headaches are those where the headache itself is the disorder — think migraine, cluster and tension-type.
The vast majority of headaches in those over 50 are benign, whether they are primary or secondary in nature. So, if you are dealing with headaches, this should ease your concerns.
The second major grouping of headaches is what is termed secondary headaches. Secondary headaches are headaches resulting from another medical condition, including high blood pressure, medication side effects and yes, a life-threatening stroke, brain bleed or tumor. The prevalence of secondary headaches increases in the over 50 crowd. Even so, the incidence of secondary headaches is still quite low, only making up around 2.2 percent of those in this age group experiencing headaches.
In other words, the vast majority of headaches in those over 50 are benign, whether they are primary or secondary in nature. So, if you are dealing with headaches, this should ease your concerns.
When you should worry about headaches
But when should you be concerned about a headache? Let’s break it down. If you are experiencing a headache as well as the following symptoms, you should seek emergency care to be evaluated. These are symptoms of potentially life-threatening conditions.
- Recent head trauma, even minor
- Fever and a stiff neck
- Worst headache of your life
- Sudden in onset and severe in nature
- Stroke-like symptoms (including difficulty moving an arm or leg, confusion or disorientation)
Now that we have the most emergent concerns out of the way, we can discuss the not-quite-emergent-but-still-urgent concerns. These symptoms require a prompt office visit with your primary care physician or with a headache specialist:
- New onset of headaches
- Any change in your current headaches, including changes in location, severity, frequency, character or new symptoms (such as visual disturbances, numbness or tingling, and dizziness, to name a few)
- Headaches and recent unintentional weight loss or a history of cancer
In summary, the clear majority of headaches experienced at any age are nonthreatening primary or secondary headache disorders. These headaches typically improve with education, lifestyle or diet changes and/or treatment.