The fear of brain tumor headaches is what drives many patients to their primary care doctor or to a headache clinic. Most times they present to the office afraid of their symptoms and convinced they may have a brain tumor . Believe it or not, clinicians do take this seriously but it is dependent on the patient’s symptoms and the results of the physical exam.
When a headache does occur from a brain tumor it is termed a secondary headache because some other medical problem is causing the pain. This is also known as an organic headache. Brain tumors are rare, even in people with recurring headache. When they do occur about 50% of the patients present with headache, and many will also have seizures and other neurological problems such as memory loss and personality changes.
Brain Tumors vs Other Headaches
Typical brain tumor headaches may have pain all over the head that is throbbing in nature. The headache may be mild in the morning and then progress and worsen during the day. They may also worsen over a period of months. Some people have had migraine type symptoms with tumors . Some types of tumors may obstruct cerebrospinal fluid which results in a headache that is positional..it is relieved when the person lays down.
This is different from other headaches such as tension and migraine which are considered primary headaches (no underlying medical problem). Tension and migraine headaches tend to be throbbing and pulsating headaches and are generally not all over the head.
At times, symptoms and complaints from patients may alert a doctor and these are called “red flags”. Although they can happen with migraines and tension headaches they might require further workup. Red flags include headaches that worsen with coughing, sneezing or bending over. Any weakness is a concern as are visual changes, memory and personality changes.
Certain things put people at risk for tumors in the brain. These include:
- previous history of breast, prostate, lung or neck cancer
- smoking (get it?)
Neuroimaging In Brain Tumor Headaches
More often than not, headache is not the complaint that leads to a tumor . Most patients present with other neurological symptoms described above. I should note that the symptoms can also include dizziness, tinnitus and incontinence. When an exam is abnormal and a patient has visual defects or weakness then either a CT or MRI of the brain is needed. Contrast MUST be given as parts of a tumor will appear different on imaging when contrast is present. After imaging, the doctor may have to do a lumbar puncture or spinal tap if the results of the imaging warrant this.
Treatment Of Brain Tumors and the Headache
Treatment of tumors is directly related to the type of tumor . Some need surgery, some need chemotherapy and radiation and sometimes, with benign tumors they are just watched for awhile. This means serial MRI’s every couple of months. The headaches are treated symptomatically and generally respond well to steroids or anti-inflammatories. Many times the brain tumor headaches disappear after surgery.