Does a brain tumor headache require urgent treatment

In what clinical scenarios does a brain tumor headache require urgent treatment?

There are few emergencies associated with brain tumor headache. Although it has an indolent presentation, the acute change in the nature of the headache with severe neurologic deficit could be an indication of worsening conditions. The most common cause of acute change in brain tumor headache is due to hemorrhage. Some primary brain and metastatic tumors such as oligodendroglioma, hemangioblastoma, melanoma, renal cell carcinoma, choriocarcinoma, and lung cancer have the propensity to bleed. Melanoma has a high frequency of intraparenchymal hemorrhage, and in some instances, a patient may present to the emergency department with acute neurologic deficits due to the hemorrhage. Hemorrhage in the supratentorial space would present with focal and lateralizing neurologic signs, while posterior fossa hemorrhage with brain stem compression can render patients unresponsive and possibly lead to death if neurosurgical intervention is not provided in a timely fashion.

Brain tumor headache associated with increased intracranial pressure can present with nonfocal neurologic signs such as a decreased loss of consciousness, nausea, and vomiting. CSF flow obstruction with tumors located within the ventricular space, such as central neurocytoma, ependymoma, and colloid cyst, or those compressing the ventricular outlets can cause acute change in headache with signs of increased intracranial pressure.

Brain tumors resulting in significant brain parenchymal irritation or mass effect often cause severe vasogenic edema. This can result in a change in headache character that may be accompanied by focal neurologic symptoms and signs of increased intracranial pressure. Corticosteroids reduce the vasogenic edema and typically provide headache relief associated with the edema. At one point, the “steroid test” was used as a diagnostic tool for brain tumor headaches. A dramatic response to steroid administration strengthened the diagnosis, on the theory that peritumoral edema was resolving. Over the years, however, it has become increasingly clear that steroids can relieve many types of headaches—not just those resulting from brain tumors.


Sign up to receive the trending updates and tons of Health Tips

Join SeekhealthZ and never miss the latest health information