En español | An occasional headache is typically nothing to worry about. You pop an over-the-counter painkiller and you're good to go.
Sometimes, however, a headache can indicate something more serious, especially at a certain age. “As you get older, we get more concerned that something else is going on that's causing the headache,” says Deborah Carver, M.D., a neurologist and board-certified headache specialist at UT Health San Antonio.
It's unusual for someone to develop migraines or tension headaches after age 50, so any new headache should be evaluated by a medical provider, Carver says. You should also see a doctor if you've always had headaches but your headache pattern changes.
"If you used to get a headache once a month, but you're now having them on a daily basis, that's concerning,” Carver says. “We also want to see you if the headache is located somewhere different, if the pain is different or if what's triggering your headaches changes.”
Common triggers include lack of sleep, stress, dehydration or a reaction to alcohol. Here are some red-flag symptoms that doctors say should prompt you to get your headache checked out right away.
1. Pain plus fever
A headache with a fever usually indicates you have some type of infection, which could be a run-of-the-mill sinus infection or something more serious like COVID-19 or encephalitis (inflammation of the brain.) If you also have a stiff neck, your doctor may suspect meningitis.
Encephalitis and meningitis can sometimes also cause confusion and difficulty talking. Both can be life-threatening if not treated right away. “Older individuals are more immune-compromised, so they are at slightly increased risk for some of these infections,” Carver says.
Tell a doctor if you have headaches
Even if you have no red-flag symptoms with your headaches, it's still a good idea to talk to a health care provider about them, says Mary Ann Mays, M.D., of the Cleveland Clinic. “Self-treating can sometimes lead to more harm,” she adds. For example, taking ibuprofen regularly can have a negative effect on your kidneys.
Don't assume you have to live with your headaches if they are affecting your quality of life, Mays says. “Some patients may have given up trying to treat their headaches years ago, but there are a lot of new treatments that have a good safety profile.”
2. A ‘thunderclap’ onset
This is a severe headache that comes on suddenly ("like being struck by thunder,” Carver says) and feels like the worst headache of your life.
Especially if the pain starts when you're exerting yourself physically, this type of headache may be a sign of a ruptured blood vessel in your brain called an aneurysm. Other symptoms include neck stiffness or an altered mental state. It's important to get help fast because a ruptured aneurysm causes bleeding that can quickly become life-threatening, Carver says.
A thunderclap headache may also be a stroke symptom, particularly if it's paired with confusion, trouble talking or weakness on one side.
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3. Temple tenderness or pain
If you are over age 50 and have a throbbing headache that's concentrated in the temple area, you may have a condition called giant cell arteritis, or temporal arteritis, which means the blood vessels in your head are inflamed. Other symptoms include jaw pain or trouble chewing, tenderness of your scalp or temples, fatigue, flu-like symptoms or vision changes. The condition is more common in women than men.
A headache caused by giant cell arteritis may progressively worsen or it may go away and come back. Either way, it's important to get it checked out quickly, says MaryAnn Mays, M.D., a neurologist at the Cleveland Clinic. “It can cause a sudden loss of vision if you don't catch it in time,” she says.
4. Ache after a head injury (especially if you're on blood thinners)
If you notice a headache several hours or even several days after hitting your head, it could be the first sign of dangerous bleeding inside your skull, known as a subdural hematoma, Mays says.
"It may have been a week ago since you fell, but you can get some delayed bleeding, especially if you're on blood thinners,” Mays says. “Even if you're not on blood thinners, any older adult who has had a recent fall and then gets a headache definitely needs to be evaluated right away. Doing so can be lifesaving.”
Other signs of a hematoma are confusion, weakness and fainting. Symptoms typically worsen over time.
5. Tooth or face discomfort
If your pain seems to be in your face and feels at times like an electric shock, you may have a nerve problem known as trigeminal neuralgia. The pain may be triggered by chewing, washing your face or brushing your teeth. While the condition can be treated with medication, it sometimes takes a while to get diagnosed, Mays says. “At first, the pain may seem like it's in a tooth, so patients often go to the dentist. Sometimes, patients undergo root canals that are unnecessary."
6. Vision problems
An ache that feels like it's in or around one eye — especially if accompanied by vision problems — can signal acute glaucoma (also called closed-angle glaucoma). Unlike open-angle glaucoma, which progresses slowly and without symptoms, acute glaucoma is a sudden buildup of pressure or fluid in the eye that damages the eye's optic nerve. It's an emergency that can lead to complete vision loss within 48 hours, so it's important to get to a hospital quickly.
7. Pain when you wake up
Morning headaches can be a sign of many different problems, including a brain tumor, neck arthritis or medication withdrawal. If other people who live with you also have headaches, carbon monoxide poisoning could be the culprit. If you have a history of cancer, a morning headache may indicate a neoplasm in the brain.
However, the most common diagnosis in older people who wake up with a headache is sleep apnea, Carver says. Sleep apnea typically causes a morning headache that gets better as the day goes on. You may also feel tired during the day. It's important to be evaluated if you think you may have sleep apnea because if it's not controlled, you are at greater risk of stroke and heart attack.
8. Additional neurological issues
It probably goes without saying that if you have any confusion, memory problems, seizures, muscle weakness, numbness or trouble talking — along with your headache — that is a reason for concern, Carver says. Those are all neurological symptoms that indicate something is going on inside your brain, whether it's inflammation, infection or a brain tumor. Your health care provider can order a scan and other tests to make a definitive diagnosis.
Michelle Crouch is a contributing writer who has covered health and personal finance for some of the nation's top consumer publications. Her work has appeared in Reader's Digest, Real Simple, Prevention, The Washington Post and The New York Times.