Overview of Brain Tumor Headaches
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Colleen Doherty, MD
Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.
Medically reviewed by Diana Apetauerova, MD on July 26, 2020
Diana Apetauerova, MD, is board-certified in neurology with a subspecialty in movement disorders. She is an associate clinical professor of neurology at Tufts School of Medicine.
Diana Apetauerova, MD
About Brain Tumors
The majority of headaches are not worrisome, and while headaches can be especially burdensome (particularly a migraine or cluster headache), they usually go away eventually with time and/or medication.
The headache of a brain tumor, however, does not go away. It's constant (or becomes increasingly frequent) even when you are sleeping. It can also be accompanied by other alarming signs, like seizures and/or fainting. That being said, headache is sometimes the only symptom of a brain tumor.
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A brain tumor is a group of abnormal cells that form a mass. Some are benign and non-cancerous, while others are malignant. As these cells grow, the tumor can press on blood vessels in the brain or the brain itself, causing a headache and other neurological symptoms.
For about half of all brain tumor patients, headache is the worst symptom. This type of headache is typically dull, persistent, and worsens with the Valsalva maneuver (like when coughing or bearing down during a bowel movement).
The headache often occurs or is worse on the same side as the tumor, but may also be generalized. This tends to happen due to increased intracranial pressure (ICP) or hydrocephalus—excessive cerebrospinal fluid (CSF) in the brain.
CSF is the normal fluid that surrounds and cushions your brain and spinal cord. If a tumor obstructs the normal flow of this fluid, it causes a buildup, creating lots of pressure. As you can imagine, this pressure may cause various symptoms including pain, vomiting, seizures, and papilledema—a sign that doctors can see when performing an eye exam.
A headache from increased ICP or hydrocephalus is diffuse and non-throbbing (more dull and does not feel like a migraine) and is associated with one or more of the following features:
Worsened by physical activity and/or maneuvers that will increase intracranial pressure (ICP). Examples of such maneuvers include coughing or sneezing (Valsalva maneuver)
Pain occurs in "attack-like episodes."
A brain tumor that causes hydrocephalus and an accompanying headache will be seen on a CT or MRI of the brain. Surgical removal of the entire tumor or part of the tumor will allow the fluid buildup to decrease (it now has a place to go), and this should alleviate a hydrocephalus-induced headache.
It's important to note that a brain tumor can cause an array of symptoms besides a headache, including:
Prolonged nausea and vomiting
Mood disturbances (i.e. depression) and/or personality changes
Difficulty with language (i.e. slurred speech)
Could It Be a Brain Tumor?
If you are experiencing symptoms of a brain tumor headache, see a neurologist who will perform diagnostic tests, including:
Neurologic exam: Your doctor will perform tests of mental functioning, alertness, reflexes, and strength.
Eye exam: Swelling from tumors can press against the nerve of the eye and may be visible through an eye exam.
CT Scan: Computed tomography (CT) scan is a series of X-ray images taken from different angles to create a cross-section image of the brain.
MRI: Magnetic resonance imaging uses a strong magnetic field and radio waves to create a detailed image of the brain.
Angiogram or arteriogram: Similar to x-ray, these tests use a dye injected into an artery prior to images being taken.
Myelogram: Another x-ray technique, this test uses a dye injected into the spinal fluid prior to imaging.
How a Brain Tumor Is Diagnosed
Headaches come in many shapes and sizes and vary in degrees from mild annoyance to crippling pain. If headaches are affecting your daily life, see your doctor. Other serious causes of headaches that are not associated with brain tumor include:
Stroke: In addition to a headache, stroke symptoms include vision changes, trouble speaking, and weakness in one side of the body. Unlike the consistent pain of a brain tumor, a headache from a stroke comes on quickly.
Brain Aneurysm: On its own, an aneurysm may cause a mild headache due to the pressure of it expanding in the brain. However, the pain from a ruptured aneurysm comes on quickly, like in stroke. This type of headache comes on suddenly and is described as massive pain or the worst headache of your life. Other symptoms include nausea, vomiting, weakness, or drowsiness.
Meningitis: A headache accompanied by a stiff neck and fever may be meningitis, an infection that affects the membranes covering the brain and spinal cords. Nausea, vomiting, and seizures may also occur with meningitis.
Migraine: An intense headache that can interfere with your daily routine, migraines often include nausea, vomiting, and sensitivity to bright lights and loud noises. While migraine can last several hours or even days and recur several times a month in some individuals, it differs from the constant pain associated with a brain tumor.
Cluster Headaches: Cluster headaches are extremely painful and debilitating headaches that come on quickly and reach peak pain levels in five to 10 minutes. They tend to occur on one side of the head and can pass quickly or last for hours. The key feature is they recur in clusters, typically striking at the same time of day, for several days or months, and may occur only in certain seasons, or year-round. They are often called "suicide headaches" because the pain is so intense and returns daily.
Most headaches are not brain tumors. But a persistent headache or one that follows a different pattern from your typical headache is a sign that you need to speak with your doctor.
On occasion, a headache from a brain tumor can cause a sudden, explosive "thunderclap headache," which may even lead to a loss of consciousness—this requires emergency medical attention.
Remember too, not all brain tumors even cause headaches. Other symptoms, like behavior changes or muscle weakness, might be the only clue. If you have any concerns, please speak with your healthcare provider.
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National Institute of Neurological Disorders and Stroke. Cerebral aneurysms fact sheet. Updated August 13, 2019.
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