Brain tumor headache
- Christine L Lay, MD, FRCPC
Christine L Lay, MD, FRCPC
- Associate Professor
- Women's College Hospital
- Christina Sun-Edelstein, MD
Christina Sun-Edelstein, MD
- Department of Clinical Neurosciences
- St. Vincent's Hospital
Headache is one of the most common complaints encountered in clinical medicine. Though the vast majority of headaches are caused by primary headache disorders, more ominous etiologies, such as cerebral neoplasm or metastatic disease, may also be heralded by headache. This topic will review headache related to brain tumors. Other clinical aspects of brain neoplasms are discussed separately. (See "Clinical presentation and diagnosis of brain tumors" and "Risk factors for brain tumors".)
The approach to evaluating headache in adults and children is reviewed elsewhere. (See "Evaluation of headache in adults" and "Headache in children: Approach to evaluation and general management strategies" and "Evaluation of the adult with headache in the emergency department" and "Emergent evaluation of headache in children".)
MECHANISMS OF HEADACHE
Traction on the large blood vessels and dura as well as direct compression of cranial and cervical nerve fibers by the tumor itself are the likely mechanisms for headaches attributed to brain tumors [1-3]. Of note, the brain parenchyma is insensitive to pain. Structures that are sensitive to pain include the following [2,3]:
●The large arteries at the base of the brain and the first few centimeters of their immediate branches
●The meningeal arteries
- Northfield DWC. Some observations on headache. Brain 1938; 61:133.
- Ray BS, Wolff HG. Experimental studies on headache. Pain-sensitive structures of the head and their significance. Arch Surg 1940; 41:813.
- Dalessio DJ. Mechanisms of headache. Med Clin North Am 1978; 62:429.
- Edmeads J. Brain tumors and other space-occupying lesions. In: Blue Books of Practical Neurology: Headache, Butterworth-Heinemann, Newton 1997. p.313.
- Pfund Z, Szapáry L, Jászberényi O, et al. Headache in intracranial tumors. Cephalalgia 1999; 19:787.
- Loghin M, Levin VA. Headache related to brain tumors. Curr Treat Options Neurol 2006; 8:21.
- Goffaux P, Fortin D. Brain tumor headaches: from bedside to bench. Neurosurgery 2010; 67:459.
- Purdy RA, Kirby S. Headaches and brain tumors. Neurol Clin 2004; 22:39.
- Jaeckle KA. Causes and management of headaches in cancer patients. Oncology (Williston Park) 1993; 7:27.
- Forsyth PA, Ponser JB. Intracranial neoplasms. In: The Headaches, 2nd edition, Olesen J, Tfelt-Hansen P, Welch KMA (Eds), Raven Press, New York 2000. p.849.
- Valentinis L, Tuniz F, Valent F, et al. Headache attributed to intracranial tumours: a prospective cohort study. Cephalalgia 2010; 30:389.
- Forsyth PA, Posner JB. Headaches in patients with brain tumors: a study of 111 patients. Neurology 1993; 43:1678.
- Salcman M, Kaplan R. Intracranial tumors in adults. In: Comprehensive textbook of oncology, Moossa A, Robson M, Schimpff S (Eds), Williams and Wilkins, Baltimore 1986. p.617.
- Schoenberg B. Nervous system. In: Cancer epidemiology and prevention, Schotterfeld D, Joseph F (Eds), WB Saunders, Philadelphia 1982. p.968.
- Kirby S, Purdy RA. Headache and brain tumors. Curr Neurol Neurosci Rep 2007; 7:110.
- Lavyne MH, Patterson RH. Headache associated with brain tumor. In: Wolff’s headache and other head pain, 5th edition, Dalessio D (Ed), Oxford University Press, New York 1987. p.343.
- Schankin CJ, Ferrari U, Reinisch VM, et al. Characteristics of brain tumour-associated headache. Cephalalgia 2007; 27:904.
- Pepin EP. Cerebral metastasis presenting as migraine with aura. Lancet 1990; 336:127.
- PEARCE JM, FOSTER JB. AN INVESTIGATION OF COMPLICATED MIGRAINE. Neurology 1965; 15:333.
- Debruyne J, Crevits L, Vander Eecken H. Migraine-like headache in intraventricular tumours. Clin Neurol Neurosurg 1982; 84:51.
- Schlake HP, Grotemeyer KH, Husstedt IW, et al. "Symptomatic migraine": intracranial lesions mimicking migrainous headache--a report of three cases. Headache 1991; 31:661.
- SYMONDS C. Cough headache. Brain 1956; 79:557.
- Rooke ED. Benign exertional headache. Med Clin North Am 1968; 52:801.
- Mascellino AM, Lay CL, Newman LC. Stabbing headache as the presenting manifestation of intracranial meningioma: a report of two patients. Headache 2001; 41:599.
- Porta-Etessam J, Ramos-Carrasco A, Berbel-García A, et al. Clusterlike headache as first manifestation of a prolactinoma. Headache 2001; 41:723.
- Tajti J, Sas K, Szok D, et al. Clusterlike headache as a first sign of brain metastases of lung cancer. Headache 1996; 36:259.
- Masson C, Lehericy S, Guillaume B, Masson M. Cluster-like headache in a patient with a trigeminal neurinoma. Headache 1995; 35:48.
- Massiou H, Launay JM, Levy C, et al. SUNCT syndrome in two patients with prolactinomas and bromocriptine-induced attacks. Neurology 2002; 58:1698.
- Smith RM, Robertson CE, Garza I. Orthostatic headache from supratentorial meningioma. Cephalalgia 2015; 35:1214.
- Medina JL. Organic headaches mimicking chronic paroxysmal hemicrania. Headache 1992; 32:73.
- Butowski NA. Epidemiology and diagnosis of brain tumors. Continuum (Minneap Minn) 2015; 21:301.
- The epidemiology of headache among children with brain tumor. Headache in children with brain tumors. The Childhood Brain Tumor Consortium. J Neurooncol 1991; 10:31.
- Wilne SH, Ferris RC, Nathwani A, Kennedy CR. The presenting features of brain tumours: a review of 200 cases. Arch Dis Child 2006; 91:502.
- Iversen HK, Strange P, Sommer W, Tyalve E. Brain tumor headache related to tumor size, histology, and location. Cephalalgia 1987; 7 (Suppl 6):394.
- Vázquez-Barquero A, Ibáñez FJ, Herrera S, et al. Isolated headache as the presenting clinical manifestation of intracranial tumors: a prospective study. Cephalalgia 1994; 14:270.
- Davies E, Clarke C. Early symptoms of brain tumours. J Neurol Neurosurg Psychiatry 2004; 75:1205.
- Rossi LN, Vassella F. Headache in children with brain tumors. Childs Nerv Syst 1989; 5:307.
- Kunkle EC, Ray BS, Wolff HG. Studies on Headache: The Mechanisms and Significance of the Headache Associated with Brain Tumor. Bull N Y Acad Med 1942; 18:400.
- Suwanwela N, Phanthumchinda K, Kaoropthum S. Headache in brain tumor: a cross-sectional study. Headache 1994; 34:435.
- Lyons MK, Kelly PJ. Posterior fossa ependymomas: report of 30 cases and review of the literature. Neurosurgery 1991; 28:659.
- Guillamo JS, Monjour A, Taillandier L, et al. Brainstem gliomas in adults: prognostic factors and classification. Brain 2001; 124:2528.
- Benitez-Rosario MA, McDarby G, Doyle R, Fabby C. Chronic cluster-like headache secondary to prolactinoma: uncommon cephalalgia in association with brain tumors. J Pain Symptom Manage 2009; 37:271.
- Levy MJ, Jäger HR, Powell M, et al. Pituitary volume and headache: size is not everything. Arch Neurol 2004; 61:721.
- Rizzoli P, Iuliano S, Weizenbaum E, Laws E. Headache in Patients With Pituitary Lesions: A Longitudinal Cohort Study. Neurosurgery 2016; 78:316.
- Purdy RA. Clinical evaluation of a patient presenting with headache. Med Clin North Am 2001; 85:847.
- Frishberg BM, Rosenberg JH, Matchar DB, et al. Evidence-based guidelines in the primary care setting: Neuroimaging in patients with nonacute headache. http://www.aan.com/professionals/practice/pdfs/gl0088.pdf (Accessed on October 14, 2011).
- Silberstein SD. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000; 55:754.
- Lear J, Weston P. CT scanning and pseudotumour cerebri. Lancet 1994; 343:1638.
- Practice parameter: the utility of neuroimaging in the evaluation of headache in patients with normal neurologic examinations (summary statement). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 1994; 44:1353.
- Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33:629.
- Yung WK, Albright RE, Olson J, et al. A phase II study of temozolomide vs. procarbazine in patients with glioblastoma multiforme at first relapse. Br J Cancer 2000; 83:588.
- Middleton MR, Grob JJ, Aaronson N, et al. Randomized phase III study of temozolomide versus dacarbazine in the treatment of patients with advanced metastatic malignant melanoma. J Clin Oncol 2000; 18:158.
- Plotkin SR, Wen PY. Neurologic complications of cancer therapy. Neurol Clin 2003; 21:279.
- Kalaycio M, Mendez Z, Pohlman B, et al. Continuous-infusion granisetron compared to ondansetron for the prevention of nausea and vomiting after high-dose chemotherapy. J Cancer Res Clin Oncol 1998; 124:265.
- Einhorn LH, Nagy C, Werner K, Finn AL. Ondansetron: a new antiemetic for patients receiving cisplatin chemotherapy. J Clin Oncol 1990; 8:731.
- Gee JR, Ishaq Y, Vijayan N. Postcraniotomy headache. Headache 2003; 43:276.
- Gantenbein AR, Sarikaya H, Riederer F, Goadsby PJ. Postoperative hemicrania continua-like headache - a case series. J Headache Pain 2015; 16:526.
- Mokri B. Posture-related headaches and pachymeningeal enhancement in CSF leaks from craniotomy site. Cephalalgia 2001; 21:976.