Headaches

This section has been reviewed and approved by the PLWC Editorial Board , 03/06

Headaches are generally divided into two main categories: primary headaches and secondary headaches. Primary headaches include migraines, cluster headaches, and tension headaches (also know as muscle contraction headaches). Secondary headaches are headaches caused by another medical condition or underlying factor, such as a brain tumor, head injury, infection, or medication. Almost everyone gets an occasional headache, and both primary and secondary headaches are relatively common in people living with cancer.

Causes

Headaches may be caused by the following factors:

• Cancers, including brain cancer, tumors of the spinal cord, pituitary gland tumors, nasopharyngeal cancer, and lymphomas of the brain
• Other cancers that metastasize (spread) to the brain, such as breast cancer, lung cancer, or melanoma
• Infections, such as sinusitis and meningitis
• Some chemotherapy, such as fluorouracil (5-FU), procarbazine (Matulane), and temozolomide (Temodar)
• Other medications, such as some antibiotics and heart medications
• Radiation therapy to large areas of the brain
• Biologic therapies (the use of substances, made by the body or created in a laboratory, to support or stimulate the body's own immune system to fight the cancer), including monoclonal antibody therapy, colony-stimulating factors, and interferons
• Other conditions or symptoms related to cancer or cancer treatments, such as anemia, hypercalcemia, thrombocytopenia, and dehydration caused by severe vomiting
• Stress, fatigue, anxiety, and insomnia may also cause an increase in primary headaches, such as migraines and tension headaches

Symptoms

Not all headaches are the same. Headache symptoms are described in terms of several characteristics.

• Timing; the time of day of the headache may help determine the cause. For example, early morning headaches associated with diplopia (double vision) may be associated with brain tumors, whereas headaches that occur later in the day are more often tension headaches.
• Frequency refers to how often the headache occurs, such as occasionally, weekly, or daily.
• Duration refers to how long the headache lasts, ranging from minutes to hours to days. Some headaches start and end very suddenly, whereas others come and go over several hours or days.
• Location refers to where the pain is situated, such as over the eyes, in the forehead or temples, at the back of neck, or on one side of the head.
• Severity refers to the degree of pain, ranging from mild to severe and incapacitating. Some headaches start with mild pain that gradually becomes more severe. In other cases, pain severity remains constant.
• Quality refers to the type of pain experienced, such as throbbing, stabbing, piercing, pressure, or a dull ache.
• Associated symptoms may include nausea, vomiting, dizziness, blurred vision, sensitivity to light or noise, fever, difficulty moving or speaking, and pain that increases with activity.

Diagnosis

Tell your doctor if you are experiencing frequent or severe headaches, or if you notice a change in the pattern or frequency of existing headaches such as migraines or tension headaches.

Your doctor will determine the type and cause of a headache based on headache symptoms, medical history, and a physical examination. A complete description of your symptoms can help your doctor make an accurate diagnosis. Keeping a headache diary to track your symptoms can be helpful. Your doctor may also order tests such as blood tests, a computerized tomography (CT) scan (a three-dimensional picture of the inside of the body), or magnetic resonance imaging (MRI) of the brain (an MRI uses magnetic fields, not x-rays, to produce detailed images of the body).

Management

Medications are used to treat primary and secondary headaches. When possible, secondary headaches are treated by treating the underlying condition. Medications are used both to treat and prevent headaches, and may include the following:

• Over-the-counter pain relievers, such as acetaminophen (Tylenol) and ibuprofen (Advil)
• Prescription narcotic pain relievers, such as codeine
• Tricyclic antidepressants
• Triptan medications, such as sumatriptan (Imitrex)
• Steroid medications, especially to treat headaches caused by the metastasis of cancer to the brain
• Antibiotics, if an infection is causing the headache

Getting enough sleep, eating well, and reducing stress may also help reduce the number and severity of headaches.

In addition to treatments prescribed by your doctor, some patients may use complementary medicine to help relieve and prevent headaches. Complementary techniques include acupuncture, massage, visual imagery, and relaxation training. Talk with your doctor about controlling headaches with complementary medicine.

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