Abstract Headache and facial pain generally become less frequent as people age, but nonetheless remain common problems in the older population, with a one year prevalence of about 50%. Primary headache disorders such as tension-type headache, migraine, or cluster headache may present de novo, or persist into old age; atypical features may become more common, and attacks more difficult to treat. Rarer primary disorders causing headache or facial pain, such as trigeminal neuralgia, short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT syndrome), hypnic headache, and primary cough headache predominantly or exclusively affect older people, but secondary headache and facial pain disorders are likely to account for a greater percentage of diagnoses. Such disorders may be benign, such as cervicogenic headache, or potentially very serious, such as giant cell arteritis or subdural haematoma. Assessment and management of pain in older people may be challenging.