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Most headaches and neck aches are not caused by brain tumours. However, half of brain tumour patients will experience increasingly severe and frequent headaches along with other systemic and neurological symptoms. As tumours damage brain tissue, tumours occurring at parts of the brain which control function will cause weakness, numbness, double vision, loss of coordination, and loss or difficulty with speech. If the tumour affects the motor area within the brain structure, the patient may suffer from seizures.

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Debilitating pain can affect the head, neck or even upper back, as tumours advance and exert greater intracranial pressure.

When should I see a neurosurgeon about my headache?

Headaches are dangerous if you experience the following, accompanied by these symptoms.

1. Thunderclap headache: This is a severe headache which comes on suddenly. It reaches its maximum severity within a couple of minutes, and lasts about five minutes. The pain is so intense that it may cause nausea and vomiting. It can be felt as a headache, neck ache or upper back ache. Head to the emergency department immediately, as a thunderclap headache may be a sign of bleeding in or around your brain
2. Positional headache: This headache changes in intensity when you stand up, lie down or sit down. The pain can be described as severe, pressure-like, throbbing, pounding, stabbing or aching. Most positional headaches are caused by a cerebrospinal fluid (CSF) leak, which could have been brought on by a brain tumour, among other reasons.
3. Headaches initiated by exertion: This type of exertional headache is brought on by physical exercise, coughing, sneezing, and/or straining.
4. New headaches: Take note of new headaches, especially if you are older than 50 years of age, or if you have a medical condition that makes worrisome headaches more likely (e.g. history of cancer, taking blood thinners).
5. Substantial change in headache pattern: Headaches are common but if you experience a significant increase in headache frequency or intensity, pay attention.
6. Constant pain in the same area of the head that does not resolve despite taking painkillers.
7. Headache that does not go away completely.

Systemic symptoms which may accompany a headache in the presence of a brain tumour include:

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• Fever
• Chills
• Weight loss
• Night sweats

A recent history of head injury should be taken into account when diagnosing headaches, as the trauma may have led to a blood clot accumulating within the skull.

Common brain tumours

There are two general groups of tumours.

Secondary tumours

Secondary tumours, also known as metastatic tumours, are the most common type of brain tumour. These are tumours that began as cancer elsewhere in another part of the body (e.g. breast, kidney, prostate) and later spread to the brain.

Primary tumours

Primary brain tumours are those which originate within brain tissue. They are classified by the type of tissue in which they arise. The most common brain tumours are gliomas, which begin in the glial (supportive) tissue. These occur in adults from age 30 onwards. Some types of gliomas specifically affect children.

Diagnosis

The presence of brain tumour does not always equate to brain cancer. Most primary brain tumours can be benign tumours like low-grade astrocytomas, meningiomas and ependydomas. These are not aggressive although they may recur after surgical excision.

Aggressive brain tumours like Grade 4 astrocytomas tend to grow fast and keep recurring, invading multiple areas of the brain.

Imaging studies like MRI and CT scans are commonly used to localise and identify brain tumours. Usually a brain biopsy is needed, too. Other studies, like CSF cytology (taking cells from the spinal fluid) may be needed.

This article has been verified medically by Dr James Tan Siah Heng, consultant neurosurgeon at Surgi-TEN Specialists, Farrer Park Hospital (Singapore).

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