The approach to the assessment and management of elderly patients presenting to the emergency department (ED) with headache is similar to the general approach to headache in this setting, in that the initial focus should be on differentiating primary vs. secondary headache and initiating an appropriate work-up where necessary. However, the index of suspicion for secondary headaches should be higher in this population, especially in the case of a new headache. Once secondary headache has been ruled out, the choice of pain interventions in this population requires a relatively greater emphasis on medication contraindications, side-effects, and medication interactions, given the general medical profile of the elderly patient. Unfortunately, evidence-based treatment recommendations are precluded by a lack of evidence specific to this population. In this chapter, we provide a general overview of the approach to the elderly patient with headache and a review of common secondary headaches in this population, and we discuss treatment options for primary headaches in the elderly.