Brain Tumor Headaches - Causes, Typical Features, Associated Symptoms, and Diagnostic Criteria

What Is a Brain Tumor Headache?

Headache is the most common symptom of tumors in the brain. But not all headaches are due to a brain tumor. In the majority of individuals, this headache is typically different from other types of headaches, and often they suffer from additional symptoms in other parts of the body. From the type and pattern of pain and other symptoms, doctors can decide whether to screen the patient for a brain tumor or not.

What Can Cause a Brain Tumor Headache?

Here, the underlying tumor is the sole cause of headaches. According to the International Headache Society, there are two particular types of headaches associated with brain tumors. They are:

• Type 1 - Headache caused directly by the tumor itself. In the beginning, the pain will be felt only in a single area of the head (localized pain). But the headaches become progressively more severe as the tumor grows. Some individuals describe the pain as ‘worse in the morning, and while coughing or straining physically.’ This type of headache probably gets better when the tumor is surgically removed or when its size goes down with treatment.

• Type 2 - Headache caused by raised intracranial pressure, which is a complication of the underlying tumor. This is the type of headache doctors normally come across with brain tumor patients. Such a headache is usually felt all over the head (generalized pain), and it is often worse in the mornings. The pain comes and goes (intermittent) every once in a while and progressively worsens as the size of the tumor increases. One may suffer nausea and vomiting as well. Headaches typically improve following surgical removal or size reduction of the tumor.

What Are the Typical Symptoms of a Brain Tumor Headache?

What makes a brain tumor headache different from other types of headaches is the timing and pattern of the headache. Following are the headache symptoms described by some patients who were diagnosed with brain tumors later on:

1. The headaches come and go every once in a while in the beginning and progressively become more severe and intense. After a while, the pain became continuous in nature.

2. Most of them describe it as a feeling of pressure inside the head.

3. Many individuals felt it as a dull ache all over the head.

4. A few of them suffered a much sharper shooting pain, more like a migraine.

5. Headaches are probably worse in the mornings.

6. Actions like bending, coughing, or straining make the pain more intense in some patients.

7. Occasionally the headache may start all of a sudden, which may be due to an acute event like bleeding in the area of the underlying tumor.

What Are the Other Symptoms Associated With Brain Tumors Apart From Headaches?

In most brain tumors, the affected individual experiences certain neurological issues apart from the headache. These symptoms arise when the tumor invades, compresses, or damages the different parts of the brain. Based on the place in the brain the tumor is located, these symptoms vary in nature. One may suffer:

• Seizures.

• Increased pressure felt in the back of the head.

• Dizziness and loss of balance.

• Weakness or numbness that gradually worsens on one side of the body.

• Double vision, blurred vision, or loss of vision.

• Hearing loss or constant ringing in the ears.

• Sudden inability to speak.

• Behavioral changes such as moodiness and anger.

• Unexplained weight loss.

What Are the Red Flags Pointing to a Possible Brain Tumor?

Doctors may suspect the presence of a brain tumor if an individual comes to them with:

1. The type of headaches mentioned above, or a visible change in the pattern of headaches that one already had.

2. Has a past medical history of cancer.

3. If the individual has a human immunodeficiency virus (HIV) infection.

4. Age above fifty.

5. Headaches that do not get better with pain medication.

6. Symptoms like seizures, weakness, numbness, or paralysis, especially on one side of the body.

7. Frequent nausea and vomiting, swelling of the eye, or vision problems.

8. Speech impairment and personality changes.

What Else Can Cause Headaches, Besides a Brain Tumor?

Brain tumors are rather rare and belong to the second type of headaches. The majority of headaches, such as tension headaches or migraines, are more common and belong to the primary headache category. Besides, tumors are not the only cause of headaches associated with raised intracranial pressure. For instance, venous sinus thrombosis may also present with a very similar type of headache and may be associated with vision problems (papilledema). It could be idiopathic intracranial hypertension (rise in pressure inside the head without reason) or obstructive sleep apnea as well, which causes morning headaches. Additionally, a hangover also causes morning headaches.

How Can One Diagnose a Brain Tumor Headache?

Telling a brain tumor headache apart from other headaches is quite hard. The doctor relies on the following factors to diagnose an underlying tumor with the headache. A good headache history, based on:

• Timing and Pattern of Headaches - What time of the day does one get them (time of onset), when is it worst in a day, how long do they last (duration), and how often do they occur (frequency)?

• Nature of the Headache - Includes where the pain is felt (pain site), a description of the type and character of pain, if there are any associated features or symptoms that come at the same time as the headache, and what makes the headache worse (aggravating factors), and what makes them better (relieving factors).

• Medical Background of the Individual - Is there any relevant medical or family history that may explain why the individual is getting headaches, such as previous cancers?

• Presence of Other Symptoms - Such as weakness or numbness, speech disturbances, ringing in the ears, or visual disturbances.

• General Symptoms - Like changes in memory or personality. The individual may not be aware of such changes happening to oneself. Hence, the doctor may need to get some additional information from the relatives or caregivers.

To confirm or rule out a possible suspicion of brain tumor, the doctor performs:

1. Thorough Neurological Examination - Involving all functional aspects of the brain such as time-place-person awareness, strength, response to stimulation, balancing, coordination, and visual field examination.

2. Imaging Studies - Such as magnetic resonance imaging (MRI) or computed tomography (CT) scan of the head can show the presence of a tumor if one is present.

Conclusion:

Brain tumors are a much rare occurrence compared to other types of headaches like tension headaches, migraines, etc. But through the headache history, if one finds features suggestive of raised intracranial pressure, it clearly is a cause for concern. Even if one’s headache does not fit the descriptions in the classification of tumor headaches, one cannot exclude the possibility of an underlying tumor without considering the associated neurological symptoms. And the doctor may go forward with the necessary tests to reach the right conclusion.