To analyze the burden, trends, and socioeconomic differences among headache disorders (HD) among older adults using the most recent data from the Global Burden of Disease (GBD) study from 1990 to 2021.

The global population is aging rapidly, yet the burden of HD in older adults remains poorly characterized, despite its profound impact on quality of life and disability. Existing epidemiological studies lack a focused analysis of this demographic, obscuring critical age-specific trends and the influence of socioeconomic development.

We analyzed prevalence, incidence, and disability-adjusted life-years (DALYs) data from the GBD from 1990 to 2021, focusing on individuals aged ≥55 years at the country, regional, and global levels. Temporal trends were quantified using Estimated Annual Percentage Change (EAPC) modeling, and the Sociodemographic Index (SDI) was used to investigate socioeconomic associations.

In 2021, 538 million older adults were affected by HD (36,219 per 100,000). Notably, the United States of America ranked among the top three countries globally for prevalence (43,133 per 100,000). While the absolute number of DALYs increased by 115% since 1990, global age-standardized rates declined (EAPC: -0.056), reflecting demographic aging. Migraine incidence increased by 1.90%, while tension-type headache decreased by 2.73%. Females carried a greater burden than males across all older adult age groups. Significant socioeconomic disparities were noted; middle-SDI regions experienced the greatest increase in prevalence, whereas high-SDI regions had the highest prevalence rates (39,639 per 100,000) in 2021. Geographically, the highest DALYs rates were in Eastern Europe, while East Asia had the highest number of cases (117.9 million).

HD represent a substantial global burden among the elderly with notable disparities among sex and SDI regions. These results underscore the need for integrated management of HD into geriatric care and implementation of region-specific global policies to reduce the burden of headache among the rapidly increasing elderly cohort.