Based on NIH | Is headache a common symptom of Alzheimer's disease, or does it usually indicate another condition?

Short answer

Headache is not typically a core symptom of Alzheimer’s disease; it more often points to another cause such as a primary headache disorder (like tension‑type headache), medication side effects, or a different neurological or medical condition. ^{[1] [2]}

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What we know about headaches in Alzheimer’s

• Headache is not a hallmark feature of Alzheimer’s. Standard symptom lists for Alzheimer’s focus on memory loss, language problems, confusion, and changes in behavior headache is not routinely included among the core signs. ^[1]

• Population studies do not show a link between “any headache” and later Alzheimer’s. In a large cohort, people reporting headaches had no increased risk of developing Alzheimer’s disease, although they did have higher risk of vascular dementia or mixed Alzheimer’s/vascular dementia. ^[2]

• Headaches may actually be reported less in established dementia. Small clinical studies in older adults with dementia found headaches present in about one-quarter, most commonly tension-type; greater cognitive impairment correlated with fewer reported headaches, likely due to underreporting or altered pain perception. ^[3]

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When headaches matter in the context of Alzheimer’s

1) Medication side effects

• Cholinesterase inhibitors (e.g., donepezil) can cause headache. Headache appears among commonly reported adverse effects in product information for donepezil. ^[4]

• Memantine can cause headache. Headache is listed as a possible side effect alongside dizziness and confusion. ^[5]

• Anti‑amyloid antibodies (lecanemab, donanemab) can rarely cause ARIA (amyloid‑related imaging abnormalities). ARIA may involve brain swelling or small bleeds and can present with headache, confusion, dizziness, vision changes, nausea, weakness, trouble walking, seizures, or even larger hemorrhage. Any new or worsening headache in someone receiving these drugs needs prompt medical attention. ^{[6] [7]}

2) Other dementia types and mimics

• Vascular causes: A history of headaches has been associated with increased future risk of vascular dementia and mixed dementia, so headache in an older adult may point more toward vascular issues than pure Alzheimer’s. ^[2]

• Autoimmune/inflammatory causes: Rapidly progressive cognitive decline with headaches can suggest autoimmune forms of dementia, which require different evaluation and can sometimes be treatable. ^[8]

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Red flags that suggest another condition

Headache in an older adult especially with cognitive symptoms deserves careful assessment because it may signal a serious problem requiring urgent care. Seek emergency evaluation if a headache is sudden and severe or accompanied by any of the following: confusion or trouble understanding speech, fainting, high fever, numbness or weakness on one side, vision loss, stiff neck, seizures, or the “worst headache of your life.” ^{[9] [10] [11]}

In primary care or neurology settings, clinicians use imaging (MRI or CT) to rule out causes like bleeding, stroke, or brain tumors when new neurological symptoms occur with headache. ^{[12] [13]} Persistent, new-onset headache in older adults can also relate to disorders such as temporal arteritis (inflammation of arteries at the temples), severe high blood pressure, infections, or medication effects. ^[14]

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Common, non‑Alzheimer’s explanations for headache

• Tension‑type or migraine: These are frequent in the general population and remain the most common headache types reported among older adults with and without dementia. ^[3]

• Medication effects: Headache may arise from Alzheimer’s symptom drugs (donepezil, memantine) or other medications frequently used in older adults. ^{[4] [5]}

• Secondary causes: Sinus disease, vision problems, dehydration, sleep issues, or cervical spine osteoarthritis can all contribute to headaches in aging. While common, these are separate from the Alzheimer’s process itself. ^[15]

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Practical guidance

• If someone with Alzheimer’s has a new or changing headache, it is reasonable to consider causes beyond Alzheimer’s itself. This includes checking medications, blood pressure, hydration, and looking for any neurological warning signs. ^{[9] [10]}

• If on anti‑amyloid therapy such as lecanemab or donanemab, treat new headaches seriously. Report symptoms promptly, as ARIA can range from mild to dangerous and may need imaging and temporary treatment changes. ^{[6] [7]}

• Imaging may be appropriate when headaches occur with cognitive changes. MRI or CT can help rule out bleeding, stroke, mass lesions, or atypical processes. ^{[12] [13]}

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Bottom line

• Headache is not a typical symptom of Alzheimer’s and often indicates another condition. Routine Alzheimer’s symptom profiles do not include headache, and large studies have not found headache to predict Alzheimer’s, though vascular dementia risk can be higher. ^{[1] [2]}

• Consider medications, primary headache disorders, and secondary medical or neurological causes when an older adult with cognitive decline reports headache. Urgent evaluation is warranted for red‑flag features. ^{[9] [10] [12] [14] [13] [3] [4] [5]}