Headache related to brain tumors

Abstract

Headache is one of the most common somatic complaints of patients seeking medical care. Most headaches are not of serious cause and can be diagnosed easily with a good history and physical examination. The challenges to the physician are to determine when underlying intracranial pathology may be causing the symptoms and signs, and to identify the few patients in whom a tumor is the cause of the headache. The subject of headache in patients with brain tumors has been reviewed in neurologic textbooks and in several investigations before, as well as after, modern imaging diagnostic techniques became available. Headache can also manifest as an acute or chronic complication of radiation treatment and/or chemotherapy in patients with intracranial neoplasm, but there are few data in the literature specifically addressing this subject. This article provides an overview of headache in patients with primary and secondary brain tumor, including headache characteristics, the putative mechanism for these headaches, the role of diagnostic testing, and the general principles of management.

Headache attributed to intracranial tumours: A prospective cohort study

“…As regards tumour-associated risk factors, we found a trend towards an increased prevalence of tumourrelated headache in association with increased ICP, consistent with previous studies (2,5). As documented in other studies, headache seems more common in infratentorial tumours (3,5), and this is probably related to the small space of posterior fossa and the obstruction of cerebrospinal fluid pathways (10). Moreover, even if the percentages of histopathological diagnoses did not differ significantly between the two groups of patients (with and without headache), multivariate logistic regression analysis revealed that GBM and secreting adenomas are associated with a higher risk of developing headache if compared with anaplastic gliomas.…”

Headache in Patients with Cancer

“…Structures that perceive pain include dura mater, cerebral vasculature, extracranial skin, periosteum, and muscle via somatic afferent input from the upper cervical and cranial nerves (especially V, IX, X) [11,12]. With progressive mass effect and the accumulation of perilesional edema and blood products, pain may be local and secondary to mechanical distortion or distant via traction on remote structures [12,13]. With global elevations in ICP seen in hydrocephalus, pain may be diffuse and unassociated with focal neurological dysfunction [7].…”

“…It is of critical importance for the clinician to have a low threshold for neuroimaging after rapid onset of severe "thunderclap" headache, nausea and vomiting, visual change, and meningeal signs, any combination of which may signify the acute vascular compromise of pituitary apoplexy [12].…”

“…The skull base is the most common site of injury and is associated with a headache prevalence of 70%, though cranial neuropathy also may cause facial pain [12]. Five pain syndromes are described with skull base Fig.…”

Brain Tumor Headaches

“…The general consensus seems to be that brain tumor headaches mimic tension-type headaches more so than any other. 4,13 Sometimes, however, brain tumor headaches are similar to migraine-like headaches (in approximately 10% of cases 4,6 ). Unfortunately, these observations indicate that the type of pain felt cannot definitively point to the correct diagnosis.…”