Brain Tumor Headaches

Abstract

Although most people who have headache pain do not present with an underlying mass lesion, a large number of patients with brain tumors do report headache (as many as 60% in our institution). The problem for clinicians is that the tumor-headache association is not universal, as evidenced by anecdotal reports of patients with large tumors and increased intracranial pressure, but a complete absence of headache pain. In this review, we examine more than 80 years of research on brain tumor headaches, delineating the link between tumor location, laterality, growth rate, and pain. Most importantly, we position our review within the context of current etiological theories and propose new models involving the peripheral and central sensitization of nociresponsive neurons. This review will help clinicians understand why debulking surgery sometimes fails to alleviate neoplastic headache pain in select patients. A brief examination of headaches as a result of surgery and adjuvant chemoradiation therapy is also provided. Headaches can be an early indicator of central nervous system tumors. However, headaches are present in a wide variety of other condition, and are sometimes (surprisingly) absent in patients with primary neoplasms or metastatic tumors. This observation complicates the possibility of linking headaches to brain tumors. Nevertheless, some generalizations concerning brain tumor headaches can be drawn. The following sections review these generalizations, presenting caveats where appropriate. Lingering questions in the field are also addressed and presented together with promising future research avenues.

Pain Characteristics of Central Nervous System Tumor in Mohammad Hoesin General Hospital

“…Malignant tumor usually presents a nonspecific and unlocalized pain because of high intracranial pressure and edema. 15 In this study, only 2 patients show different location between pain and the site of tumor. The first patient is the metastasis tumor and the other one has hydrocephalus.…”

Headache Management in Individuals with Brain Tumor

“…For some individuals, a sudden-onset, paroxysmal headache triggered by change in body position or Valsalva-like manoeuvre may occur due to transient blockage of CSF flow at the foramen of Monro (i.e., from a colloid cyst or other tumor of the 3 rd ventricle). 13,44 Despite these factors, the risk of any particular cerebral neoplasm on headache is variable. Tumors in identical locations may have differing associations with headache, 22,24 and tumors without apparent direct mass effect on pain sensitive structures have been associated with headache in some cases.…”

“…13,41 Though the brain parenchyma itself lacks pain receptors, several intra-and extracranial structures are pain-sensitive, including blood vessels, cranial nerves with afferent pain fibers (e.g., the trigeminal nerve), cervical nerves (e.g., C1 and C2), dura mater, periosteum, and extra-cranial tissue. 13,[42][43][44][45] Increased intracranial pressure can cause traction on pain-sensitive structures and trigger headache, as well. 14,46 Intracranial pressure may increase in the setting of a rapidly expanding tumor with associated cerebral edema within the cranial vault.…”

The Natural History and Treatment of Meningiomas: An Update

“…Headache, as for any other primary CNS neoplasm, is the most common patient complaint. 52 53 Seizure is another common presenting symptom in 30% of meningioma patients, with surgical resection offering 60 to 90% seizure freedom with a 12 to 19% rate of de novo seizures. 54 Factors predicting preoperative seizures in meningioma patients are supratentorial (non-skull base) tumor location (mostly convexity and parasagittal) and perilesional edema on imaging.…”