Title: Headache Associated with Intracranial Neoplasms
Abstract: In general practice, headaches are one of the most common presenting symptoms, resulting in 10–15% of office visits with approx 11 million people in the United States having migraine headaches (1). Often the cause is benign but there is nothing more worrisome than "missing" that rare patient with a brain tumor. The most common cause of headache in both adults and children remains as tension or muscle contraction type headaches. This accounts for 75% of headaches in adults and also 60–75% of headaches in children. Other causes include migraine, which occurs in 10–15% of cases. The other 10% are related to other causes and it is within this 10% that brain tumors present. In approx 60% of supratentorial based primary tumors, and 50% of metastatic brain tumors, headache is one of the main presenting symptoms (2–4). Although it is a relatively rare cause of headaches, it is the one that physicians fear the worst, and is often the main reason for multiple investigations. Unfortunately there are no typical presenting characteristics as the headache is usually described as a dull ache, steady in nature, and is "located" deep in the head (2,5,6). Certain aspects of the history, however, may be suggestive of this diagnosis (7–12). Factors such as: (1) a sudden onset of headaches in someone not prone to headaches; (2) a gradually worsening headache that seems to increase over a number of days to weeks; (3) early morning headaches, which often awaken the patient or are present on awakening; (4) improvement during the day as the patient tends to be upright; (5) worsening of the headache with any maneuver that causes an increase in intracranial pressure, such as bending, coughing, or sneezing; and (6) an association of the headache with other neurological symptoms tend to suggest the possibility of a pathological cause for headache (2, 5, 6). If the patient has a history of previous headaches, this headache usually has the same description, but may appear to be more intense with time (2,6). The rate of increase in size and the location of the tumor affect the headache more so than its size. Typically the headache is located over the area of the tumor on the ipsilateral side. The main cause of headache in brain tumors is related to a mass effect of the tumor, resulting in a traction effect on brain tissue and the surrounding structures. This is often seen in patients with: (1) an increase in intracranial pressure, and (2) a large enhancing tumor mass associated with a midline shift.
Publication Year: 2003
Publication Date: 2003-01-01
Language: en
Type: book-chapter
Indexed In: ['crossref']
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Cited By Count: 3
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