Headache in Intracranial Tumors

Abstract

The clinical data of 279 consecutive patients with brain tumors were analyzed pre- and postoperatively in the period of 1994-95. No headache had been recorded in the history of 115 patients, neither pre- nor postoperatively. Only in 139 of the remaining 164 headache patients was there a probable connection between headache and intracranial neoplasm. In the headache group the most frequent findings were metastatic brain tumors and different astrocytomas. Hypophysis adenomas and glioblastoma multiforme were frequent in the no-headache group. Progressive headache was found in 110 patients (67% of the headache group). The progressive character of the headache showed a close relationship with the prevailing edema, but not with the size of the tumor. Infratentorial and intraventricular tumors were more frequently accompanied by headache than those located supratentorially, probably due to the disturbance of CSF circulation and midline dislocation with increased intracranial pressure. Only in one-third of the patients did the site of the tumor coincide with the lateralization of headache. In half of the headache patients, pain was the first complaint. Headaches caused by tumor were characterized by pain lasting for hours, developing for weeks or months. The headache was never permanent and there was no regular daily recurrence.

The Clinical Characteristics of Secondary Headache

“…If headache was unilateral, then headache and tumour were on the same side in only 61.5% (Schankin et al [3] ). But in contrast, other previous studies had stated headache lateralisation predicted tumour location in only one third of patients (Pfund et al 1999 [2] ). Frontal headaches were the most unreliable in predicting tumour location and were most common (Valentinis et al 2010 [4] ).…”

“…In the no-headache group of patients, vestibular schwannomas (54.2%) were most commonly seen in this study. But Pfund et al [2] in their study had stated that in the headache group the most frequent findings were metastatic brain tumours and different astrocytomas. Hypophysis adenomas and glioblastoma multiforme were frequent in the no-headache group.…”

“…But previous studies have shown as follows: Forsyth and Posner [1] -48%, Pfund et al [2] -58.8%, Schankin et al [3] -60%, Valentinis et al 2010 [4] -47.6%. About 11.5% (5.29% males and 6.25% females) did not have headache during the course of illness till the time of interview.…”

“…Forsyth and Posner et al [1] who had stated that patients with unilateral headache had an ipsilateral tumour. Most patients with infratentorial tumours have supratentorial headaches only; but if occipital pain is present, an infratentorial tumour is more likely (Pfund et al [2] ). Headache has lateralising value, especially in patients with supratentorial lesions who have no obvious increased intracranial pressure (Suwanwela et al [5] ).…”

“…The Nature of the Neoplasm was obtained (1) By Neuroimaging with regard to Tumour size was defined as the product of the two largest dimensions (in cm) and was used as a measure to differentiate small (<10 cm 2 ), medium (10-20 cm 2 ) and large tumours (>20 cm 2 ). Multifocal tumours were assigned to a special category.…”