Which vascular condition must be ruled out in older adults?

• A. Temporal arteritis
• B. Migraine
• C. Hypertension
• D. Sinusitis

Answer: (A)

In older adults, new or unusual headaches with risk of vision changes must raise suspicion for temporal arteritis because it is a vasculitis of the large and medium arteries that can occlude the ophthalmic artery and cause irreversible blindness if not treated quickly. It typically affects people over age 50 and may present with a new unilateral headache, scalp tenderness, jaw claudication, and sometimes systemic symptoms; labs often show elevated ESR or CRP. Because vision loss can be permanent, treatment with high-dose corticosteroids should be started promptly when suspicion is high, even before biopsy confirmation. Migraine and sinusitis can cause headaches but do not carry the same immediate threat to vision, and hypertension is a common chronic condition rather than an acute, vision-threatening vasculitis.