Differences between a benign tension type headache and a brain tumor headache

If brain tumor headaches are most commonly tension like, how to differentiate between a benign tension type headache and a brain tumor headache?

A tension-like headache is the most common type of brain tumor headache. It is found in 77% of patients, while the migrainous headache is found in 5% to 10%. There are a number of factors that differentiate the more common tension-type headache from headaches due to a brain tumor. The most important is the presence of neurologic symptoms, including focal deficits associated with tumor location and symptoms related to raised intracranial pressure—namely nausea, vomiting, and decreased level of consciousness. An abnormal neurologic exam is not commonly associated with a benign headache, except for Horner syndrome in cluster headache. This abnormality occurs in over 50% of patients with brain tumor headaches.

Time course is another factor that differentiates a tension-like brain tumor headache from a regular tension headache. A new-onset headache that develops over time is more likely to represent a space-occupying lesion than a chronic headache that has been stable over an existing period. Furthermore, development of a new onset headache in a patient with a history of cancer should raise the suspicion for possible cerebral metastasis, and appropriate neuro-imaging should be obtained. New onset progressive headaches in elderly patients with no prior history should also alert the clinician to the possibility of a brain tumor.

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