When Is a Headache a Symptom of a Brain Tumor?

MSK neurologist and supportive care specialist Alan Carver

"Primary brain tumors are distinctly uncommon," says Memorial Sloan Kettering neurologist and supportive care specialist Alan Carver (pictured).

A bad headache can be a frightening experience. But sometimes, even scarier than the pounding in your head can be the tricks your mind plays on you as it’s happening.

When that throbbing pain gets unbearable, it’s easy to worry that your headache might be something more serious, like a brain tumor. But Alan Carver, a neurologist and supportive care specialist at Memorial Sloan Kettering, says that the vast majority of the time, a headache is not something to worry about.

“Primary brain tumors are distinctly uncommon,” says Dr. Carver, adding that only five per 100,000 people are diagnosed each year. “The honest truth is that most of the time headaches are not associated with brain tumors, though they can produce severe pain and other unpleasant symptoms.”

Vision problems and other symptoms like nausea, vomiting, and being sensitive to sound and light are much more likely indicators of a migraine headache than a mass in the brain, he says.

In fact, only about half of the time will a headache be what brings a person in to see a neurologist, he adds. The symptoms that more commonly suggest a mass in the brain are neurologic: difficulty speaking, weakness on one side of the body, and changes in vision, for example. A seizure is another tip-off, and it can take different forms. Some seizures can include convulsing and a loss of consciousness. Others can be a shorter period of prolonged involuntary movements.

When someone visits a neurologist, a further look at the brain with an MRI is only sometimes necessary. Dr. Carver can usually determine if a person’s headache warrants a closer look by considering a series of questions he abbreviates with the acronym SNOOP.

S: Systemic

“Systemic” refers to what is happening in someone’s body at the time of the headache. A person with a brain tumor likely has other symptoms, and sometimes a preexisting health condition.

“I want to know what else is going on,” Dr. Carver says. “Do they have a fever? Do they have some other illness like cancer or HIV? Is this person sick in some other way? If the person is a young adult and in good health other than the headache, I can often reassure him or her of the extreme unlikelihood of an underlying brain tumor.”

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N: Neurologic Exam

A neurologic exam is the gold-standard test given by neurologists and emergency room doctors when someone comes in with a headache. A person with a brain tumor often has a specific neurologic issue that is visible to the naked eye. The person might drag a leg when walking, have trouble speaking, or be unable to raise their arms to equal height. Every time a person has an annual check-up, their doctor is expected to perform a short neurologic exam.

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O: Onset

Many headaches that are not dangerous tend to gradually build over hours or even days. A more concerning headache comes on fast and strong, Dr. Carver says.

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O: Older

A brain tumor is much more common in older adults than in young people, Dr. Carver says. “If a 22-year-old comes to see me and meets criteria for migraine, and has a normal neurological exam, is there a reason to order an MRI? Absolutely not,” he says.

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P: Prior Headache History

When Dr. Carver meets with someone for an appointment, he asks if headaches have been an issue for that person in the past. That can help him determine if the headache is something out of the ordinary or if it is consistent with the person’s medical history.

“People with a prior history of headaches who are unlucky enough later in life to develop a brain tumor are more likely to complain of a headache than people without a history,” Dr. Carver says. “It is therefore especially important to examine people comprehensively to be certain that symptoms or signs aren’t missed.”

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Help at MSK

In the very unlikely event that a headache does lead to a brain tumor diagnosis, MSK is one of the top places in the world to come for care. People who have been diagnosed with brain tumors can receive comprehensive care through MSK’s brain tumor service, led by medical oncologist Ingo Mellinghoff. Together with Lisa DeAngelis, Chair of MSK’s Department of Neurology, Dr. Melinghoff and his team are able to offer many more brain tumor treatment options than previously existed and numerous opportunities for people to participate in clinical trials.

And there’s help even if the underlying problem isn’t a tumor. Dr. Carver says that we now know many underlying mechanics of migraines, which has led to successful treatment for most people with this debilitating disorder. He advises anyone with frequent and severe headaches to undergo a comprehensive exam to both assure that nothing is missed and to receive the benefits of successful treatment.

Brain Tumor Center
Memorial Sloan Kettering’s Brain Tumor Center brings together scientists and clinicians with the goal of developing truly effective brain tumor therapies.
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Commenting is disabled for this blog post.

My mother was diagnosed with GBM January 19, 2011. The horrible disease stole her life on June 26, 2011 six months, to the day, after her surgery.
She received radiation therapy as well as three rounds of Temodar.
Excellent care at MSKCC by Dr.'s Tabar, Kaley and wonderful nurses.

GBM is a horror. I pray for a cure or new treatment protocol. No loved one, family member, friend or individual should experience this horrific disease.

My husband only 49 was diagnosed in September of 17. Now July 2018 he is going to hospice. He did 30 days tmz with radiation. And one round of maintenance dose of tmz. It’s not effective. I don’t feel radiation is the answer, I believe it was toxic to my husband. The standard of care has to change, brain tumor doctors need to come up with natural treatments as well to help patients in a more well rounded way. It doesn’t work. I’ve been though it and if I ever had it , I would not even bother with SOC. Doctors work hard to change this please!. My two daughters are losing their father and he is a good, smart man and an attorney.

Dear Claudia, we are so very sorry for your loss. Best wishes to you and your family in this difficult time.

Good Day. I would like to send my condolences to the families who have loss their loved ones to, the devil named, brain cancer. My heart really hurts for the family members, of those, who passed on so soon after the diagnosis. My mother was diagnosed with brain cancer in August 2012 and she passed on In July 2016. I thought I was robbed, but now I realized that I was truly grateful to have my mother for the length of time that I had. My mother received chemo, radiation and even participated in a treatment study at MSK. I must say, MSK, is the best. Families, please have faith. Please do all that you can to make this process easy for the children as well.

We are very sorry for your loss. Thank you for your kind words. Best wishes to you.

I lost my father on July 20, 2016 to a short battle with GBM. I wish I could pinpoint when he started exhibiting symptoms. But I didn’t know then what I know now about GBM, which is way more than I have ever cared to know. He had no chance in fighting...the tumor was not methylated. It was a “3 strikes, you’re out” kind of tumor. He had he best of the best at MSKCC. Thank you, Drs. Tabar and Diamond and all of your staff and nurses for doing whatever you could to help my dad. RIP Cosmo Mezzina 7/20/16

Dear Maria, we are very sorry for your loss. Thank you for sharing your story. Best wishes to you and your family.

My 53 year old cousin was just diagnosed with glioblastoma and is being treated by MSK now. Praying that all is being done to save his beautif life and thank you to all the caring doctors and surgeons who devote their lives to saving others

Dear Jodi, we’re very sorry to hear about your cousin’s diagnosis. We are sending him our best wishes. Thank you for your comment.

My mother was diagnosed with a Glioblastoma at the age of 54 and had the surgery to remove the tumor, however, they told her it would come back and she would probably be gone in 4-6 months. She viewed it more like a challenge than a prognosis....She took radiation, chemo & shark cartilage - relied on her faith in a great God and kept a positive attitude. The brain tumor returned and she did die of a glioblastoma - 19 and a half YEARS later. Not all of those years were easy, but she made the most of them and we're very grateful for the many milestones we had her there for - and I know she was too. She was ready to go at any time, but as long as God and her body allowed - she was going to fight. Do not lose hope - keep fighting - I can say this because I watched and learned from the best!

Dear Jessica, we are sorry for your loss. Thank you for sharing your mother’s story.

Is MSKCC doing, or do you know anyone who is doing, genetic research on GBM? My father and both of his parents (married to each other, unrelated) all died of GBM. We have the autopsy slides from my father, he has two siblings still living, and all three of his children have had one or more cancers starting age 25-41, willing to participate in research.

Dear Rebecca, we’re very sorry to hear about your family history. If you are interested in learning more about this, you may want to contact our Clinical Genetics Service. They can be reached at 646-888-4050. Thank you for your comment, and best wishes to you.

My 70 year old husband was diagnosed with GBM in 11/2017. He initially had 2 surgeries, radiation and 7-8 cycles of Temodar. Even though his tumor was not methylated, the treatment worked for a year before his first reoccurrence. His attitude has always been positive and I have made an effort to support his conventional therapies with supplements and diet which included the food choices of the KETO/Bulletproof diets. With his first reoccurrence he had another surgery and then joined a clinical trial at MSK. Although he was not able to continue, due to complications from his disease, I can only say that the team at MSK was always supportive, involved and responsive to all of his needs. Their care was top notch and also had programs to support the caregiver as well. Although we continue the fight, it is getting harder with less treatment options, but at 16 months, we have beat the odds already. When he was diagnosed they thought 6 months. I am grateful that with the support of family, friends, and the wonderful professional medical community that is available in NYC, along with the grace of God, my beautiful, loving husband is still with us. Keep the faith!!!

Dear Anita, thank you for sharing your family’s experiences with MSK. Best wishes to you and your husband.

My wife suffers from acute headache once in a few months for 1-2 days. Few months ago she got cleaned her ears and after that felt great relief from this problem but yesterday night she again started complaining of severe headache and described it as a current flowing from right eyelid to back of head. Please suggest whether it is migraine type only or might be something concerning?

Dear Manoj, we recommend that your wife discuss this with her doctor. Thank you for your comment and best wishes to you.

For three weeks, I've been having migraines. No, they have not gone away. I cry trying to go to bed at night. I lose sleep every night. Not only are the migraines getting worse, but over time I am feeling more tired, and nauseous. P.s. the feeling like you're going to faint.

Dear Emily, we’re sorry to hear you’re going through this. We recommend that you discuss this with a doctor. Thank you for your comment and best wishes to you.

Hi I'm 40 years old and have never suffered with headaches until 2 months ago .they are getting worse and more frequent .the pain is on my forehead and on top of my head .are these migraines?

Dear Kelly, we recommend that you discuss this with your doctor. Thank you for your comment and best wishes to you.

My name is rhianna I'm 29years old , I been getting real bad head aches , I have had it as I was 11/13 years old and up till this age I don't know if its mindgraines or just headaches I feel like im going to drop or faint what should I do I'm worried

Dear Rhianna, we’re sorry to hear you’re going through this. We recommend that you make an appointment with your doctor to discuss this. He or she may refer you to a headache specialist. Thank you for your comment and best wishes to you.

Good day. I had headache for more than a month up to now. I visited my internist twice and a neurologist once. They both told me that it is a nerve headache. It's at the back of my head. I tried saridon and tramadol but it didn't help me. Now I am taking Pregabalin Lyrica but still not working. I am really confused now. 31 years old guy here. Thank you

Dear Roy, we’re sorry to hear about what you’re going through. We recommend that you continue to seek out specialists who can help to resolve your problem. Thank you for your comment and best wishes to you.

In July, 2005, my 20 year old son was diagnosed with a GBM the size of a man's fist. There were very few symptoms; some headaches, vision difficulties, and nausea & vomiting. David had an MRI on a Saturday morning and never heard from a doctor to discuss anything. I called an Oncologist I had seen for a second opinion earlier that same year when I had Stage IV Bladder Cancer. Dr. Berkowitz saw David the next day. Looked at the films of the MRI and had his Oncology Nurse give David and IV of Decadron because of the swelling in his brain. He did this in his office where he also had at least 10 Infusion suites for his patients. He admitted David to Christiana Care Medical Center. Three days later, Dr. Michael Sugarman removed the tumor from my son's head (left frontal), and felt that he had gotten it all. About a month later, we took David to MSKCC to discuss what Christiana had decided to treat David with. The doctors there were wonderful. They agreed with treatment protocol and then we went site seeing. I kept in touch with one of the docs there with David's progress. One constant side effect he experienced were seizures. In November, 2017, David was diagnosed with a GlioSarcoma Brain Tumor. Again, Dr. Sugarman removed the tumor but did not know what type it was. It was sent to the Mayo Clinic were after a few weeks of testing, it was shown to be a Sarcoma. In those two weeks, David had a tumor grow back in the same area but had begun to grown outside of his skull. It appeared to be approx and inch and a half in height and about 2 inches in width. After very aggressive radiation through Dr. Sunjay Shah at Christiana Care, this tumor just shrunk, died and fell off David's head in the middle of the night in the form of a very hard scab. Two months ago, David's Oncologist, Dr. Wolcott advised David to look into Hospice Care. After much suffering, he was wheelchair bound, weak, totally unable to walk or care for himself at all and couldn't keep down anything he was able to eat. David told her that he wasn't going anywhere and she better find a Clinical Trial which he would qualify for because he wasn't ready to die. The next day, she called him and said there was a newer Trial she was certain he would qualify for. He got in and stuck to it and I am thrilled to tell you that he is now walking with the aid of a cane and a leg brace, eating and has gained weight, and happily able to enjoy life after a long time of suffering and being homebound. Our prayers have been answered. He is also in Neuro Physical Therapy.

Dear Patti, we’re glad to hear your son is doing well. Thank you for sharing your family’s story.

So sorry! I omitted the fact that the Sarcoma had spread to his left lung and back to his brain. His last MRI showed his brain to be stable and his tumors in his lung have shrunk at least 25%. I got too excited and forgot to include this. I do apologize !