Most headaches do not signify serious disease, but when a patient with a headache syndrome does not respond to conventional therapy, a high index of suspicion for a neurologic emergency is warranted.
There are no truly unique characteristics of brain tumor headaches that are different from regular headaches, although some patients will have an increase in pain with changes in barometric pressure, during a flight, or with changes in altitude. Some have a headache when bending forward or coughing. However, absence of these signs is not unusual either. Some brain tumor patients never have a headache. Some large brain tumors never cause headache. Some small brain tumors can cause very severe headaches. The latter occurs with tumors in the ventricles that block the flow of spinal fluid.
Headaches caused by brain tumors may vary depending on the location, and many different features.
• Steady and worse upon waking in the morning and clears up within a few hours
• Persistent non-migraine headache that occurs while sleeping and is also accompanied by at least one other symptom such as vomiting or confusion
• May or may not be throbbing, depending on location of the tumor
• Accompanied by double vision, weakness, or numbness
• May worsen with coughing or exercise or with a change in body position
• Sometimes accompanied by neck pain
A tension headache, often felt as tightening in the back of the head or neck, is a common symptom in brain tumor patients who have a tumor in the back of the head, or causing pressure on the lateral ventricles, the spinal fluid spaces in the middle of the brain. The pressure from the tumor seems to transmit to the back of the head and downwards. Some patients who experience this consult with a chiropractor, thinking they have a neck problem.
Patients who have a history of migraines who develop a tumor often say their tumor headache is different from their migraine headache. They are not relieved with the same medication. Often the migraine headache is accompanied by nausea and sensitivity to light. Most brain tumor headaches are not accompanied by nausea.
Doctors consider the possibility of a brain tumor in people who have had a seizure for the first time or who have the characteristic symptoms. Although doctors can often detect brain dysfunction by performing a physical examination, other procedures are needed to diagnose a brain tumor.
Some patients have headache as the only symptom, or as the first symptom for brain tumor. Obviously not every patient with a headache gets a CT scan or MRI. Often a physician will look for some other problem such as weakness, visual problems, or dizziness before ordering a scan on a patient with a headache. Some physicians have been successfully sued because they did not order a scan after the patient complained repeatedly of headache, but the physician did not order the scan because no other signs or symptoms were present.
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