When Does a Pounding Headache Actually Signal a Brain Tumor?
When you’re hit with a pounding headache for no obvious reason, you probably assume you haven’t had enough water, didn’t sleep well, or have some muscle tension you’re holding onto due to stress.
After all, the causes of headaches and migraines can range from the foods you eat to spending too much time in front of your computer screen (guilty!). But when that ache starts to linger, feel severe, or come back often, it’s only normal to wonder if it could be pointing to something more serious.
Take a deep breath: Odds are excellent that your headache is not a brain tumor, even if you can’t get through a teen tearjerker without seeing someone (usually young, female, and lovely) expire tragically from the disease.
While a headache is sometimes one of the symptoms of a brain tumor, chances are, as a surprisingly hot Arnold Schwarzenegger put it in 1990’s Kindergarten Cop, “It’s not a toomah!”
How often is a headache a sign of a brain tumor?
“Headaches are incredibly common and brain tumors are incredibly rare,” says Cameron Brennan, M.D., a neurosurgeon at Memorial Sloan Kettering Cancer Center. “Around five out of 100,000 people a year are diagnosed with some kind of brain tumor, whereas one in seven people report a migraine each year.”
Migraine is just one cause of head pain. Tension headaches, cluster headaches, and simple but annoying caffeine withdrawal or fatigue headaches send many people to Starbucks or the medicine cabinet for a pain reliever every day.
Besides, headache or none, your lifetime risk of a malignant brain or spinal cord tumor is less than 1%, according to the American Cancer Society. And while “Yay, I have a brain tumor,” is not something you’re likely to ever hear, most primary brain tumors (more than two-thirds) are not cancerous, according to the American Brain Tumor Association. (A primary brain tumor is one that originates in the brain, as opposed to breast cancer or lung cancer, for instance, that has spread to the brain, and would have had many other indicators before a headache.)
When is a headache a sign of a brain tumor?
In order for a headache to be the telltale symptom of a primary brain tumor, it has to be pretty big, says neuro-oncologist Alyx Porter, M.D., an associate professor of neurology at Mayo Clinic in Phoenix and co-chair of the Central Nervous System Disease Group. “The skull is a fixed space, and it only allows for the brain, spinal fluid, and blood,” she says.
Plus, the brain itself can’t detect pain. “If anything else is in there, it creates pressure [on nerves of blood vessels], so a tumor would have to grow quite sizable before you feel intracranial pressure,” says Dr. Porter.
All of this to say, a headache is rarely the first or only symptom of a primary brain tumor. “It’s much more common for people to have other neurological symptoms,” possibly along with a headache, says Dr. Porter. These include seizures, vision changes, weakness on one side of your body, slurring of speech, among others. You’d probably know something was wrong before a bad headache hits.
Besides, benign brain tumors tend to grow slowly, and while they’re no fun, they sometimes don’t need to be removed, depending on how disruptive the symptoms are. “Benign tumors are often completely curable or manageable throughout a long natural lifetime,” says Dr. Brennan.
Even a malignant brain tumor doesn’t always play out like in the movies. “For the worst of the worst the kinds of brain tumors we see, there are a wide range of prognoses, and a wide range of how well people can do,” Dr. Brennan says.
What does a headache caused by a brain tumor feel like?
It feels pretty much the same as other headaches, particularly a migraine, says Dr. Brennan. “There’s not a single pattern that distinguishes a brain tumor headache from the range of normal headaches that people can get,” he says, adding that because brain tumors are all about taking up space in the skull, anything that raises the pressure in the head can trigger a headache that’s due to a brain tumor. “Sneezing, laughing, bending over—that kind of thing. But those things can exacerbate a regular headache, too.”
A headache caused by a brain tumor, however, is unlikely to come on during the day, says Dr. Porter, and may wake you up in the night or early morning hours. But that alone wouldn’t be the biggest red flag: Neurological symptoms along with a headache are a much bigger cause for concern.
When friends or family call Dr. Brennan for advice when they have a headache, he asks a few questions, including if the headache has been happening for a while. “That points to it not being concerning, even though the symptoms may be awful—the longer it’s been going on, the more likely it is to be a benign headache.”
When should you see a doctor about a headache?
If you suddenly have the worst headache you’ve ever had, or if it comes with neck pain, vomiting, high fever, difficulty speaking, confusion, or numbness or weakness, head to the ER, because there are a number of things it could be that require immediate attention.
But even when it’s not an emergency, if you’ve never had a migraine before, if it feels different than a migraine you’ve had in the past, or if it hangs around for a few days and OTC pain relievers don’t seem to help, why not have it checked out? Your doctor will likely order an advanced imaging test, like a CT or an MRI, to ensure everything’s looking normal, Dr. Porter says.
Bottom line: You don’t have to live with the pain. If a headache is interfering with your everyday life, see your doctor or a specialist, like a neurologist, to figure out what’s going on—because, chances are, it’s something other than a tumor.
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