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. Most of the time there are several symptoms and only about 2% of patients with this tumor present with headache alone.
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 headache 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 particular headache and the tumor associated with it are quite rare, but may present with severe nausea and vomiting.
What Is The Incidence Of Brain Tumors?
This type of cancer is actually quite rare, but because it sounds so frightening, many people are afraid that when they start getting headaches that they have a tumor somewhere in the brain. Only about 140 people in 1 million per year will get a brain tumor. This is FAR less that those with a new onset of headache which is over 600,000 out of a million. Remember, only 2% of the 140 tumors present with headache alone. That's about 3-4 people. Pretty uncommon isn't it?
Most patients will ask me about tumors when they find out that a family member died of a brain tumor. This type of cancer is not genetic and therefore not heriditary. None the less, if you have any concerns about a new onset of headaches, please see your doctor right away.
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?)
Obviously I am trying to make a point here. I will tell you that my supervising physician, Dr. Laszlo Mechtler will
tell his newly diagnosed brain tumor patients that virtually every case he sees has a past history of smoking for years.
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. Tumors of the brain breakdown the blood brain barrier which usually protects the brain. When this happens then contrast can get in and it is taken up by the tumor if cancerous. This is why it is important not to refuse the contrast if your doctor orders it on a scan. After imaging, the doctor may have to do a lumbar pucture or spinal tap if the results of the imaging warrent this.
Other factors raise the suspicion for brain tumor. Someone with a past history of breast cancer or lung cancer, who never had headaches before and all of a sudden gets them, is a "red flag" for clinicians. Imaging needs to be done as soon as possible to rule out metastises, which is the most common type of brain cancer. Headaches however are not seen with mets as frequently as with a primary brain tumor such as a GBM (glioblastoma multiforme) which is seen on the MRI below. Usually the pressure and edema around the mass is what is causing these brain tumor headaches.
Treatment Of Brain Tumors
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. Most often to relieve brain tumor headaches, steroids for a few weeks will ease the pain.
Remember, brain tumor headaches are rare, but if in doubt, please call your physician.
Other Conditions To Consider
There are a few other conditions that can mimic brain tumor headaches. These include an abscess of the brain, menengitis, encephalitis and intracranial hypertension which causes increased pressure in the brain. These conditions are all treated differently.
Doesn't sound like you?? Ok then read more about different types of headaches to see what kind of headache you might have.
Schankin, CJ et al. Characteristics of brain tumor associated headache.Cephalalgia 2007;27:904-11
Huff, J. Stephen. Brain Neoplasms. Medscape online from Brain Neoplasms. August 2, 2011.