Headache in the elderly: a retrospective study in a tertiary headache center

Background: Primary headaches, particularly migraine, are common neurological disorders that need to be better defined in the growing elderly population. This study provides a comprehensive evaluation of headache, with a focus on migraine, across age groups in a tertiary headache center. Methods: We retrospectively analyzed 3023 patients admitted to the Headache Center, Bari General Hospital (2017-2025). Patients were divided into four groups: young adults (18-30 years), adults (31-45), middle-aged (46-59) and elderly (≥ 60). Data collected included headache characteristics, accompanying symptoms, disability, allodynia, fatigue, anxiety and depression. Statistical analyses included chi-square tests and Kruskal-Wallis ANOVAs. Results: Of the total sample, 404 patients (13.4%) belonged to the elderly, 925 (30.6%) to the middle-aged, 1016 (33.6%) to the adult group, and 678 (22.4%) to the young group. Elderly were more likely to have received a diagnosis of tension-type, other primary or secondary headache disorders and probable diagnoses (ps < 0.001). Among 2390 migraine patients, chronic migraine was more common in the elderly (40.3%, z = 3.23). Migraine with aura occurred slightly more often in younger individuals. Older patients reported longer disease duration, longer migraine attacks, and fewer accompanying symptoms (ps < 0.01). Excessive medication use was present in a relevant proportion of elderly. Fatigue was more frequent in older patients. Conclusions: Headache types and migraine characteristics vary with age. In the elderly, chronic migraine predominates, with less autonomic impairment, longer attacks and increased fatigue. Medication overuse represents a significant concern. These findings highlight the need for age-specific diagnosis and tailored treatments in older adults.