Headache attributed to intracranial tumours: A prospective cohort study

Abstract

Between January 2007 and March 2008, we prospectively studied all patients operated on for intracranial tumours in our Department of Neurosurgery. Preoperatively, all patients were interviewed by a neurologist to collect headache characteristics. Measurements of tumour and oedema volume were made using dedicated software for magnetic resonance imaging studies. Tumour histopathology was established by histological examination postoperatively. If headache improved postoperatively, a diagnosis of 'headache attributed to intracranial neoplasm' was made, according to the 2004 International Classification of Headache Disorders (ICHD-II). A multivariate logistic regression model was used to evaluate the association of headache with potential risk factors. We studied 206 subjects. The prevalence of tumour headache was 47.6%. Intracranial tumour headache was non-specific and in most cases could not be classified by current ICHD-II diagnostic criteria for primary headache syndromes. Its prevalence varied depending on volume, location and type of tumour, as well as on the patient's previous headache history.

The Clinical Characteristics of Secondary Headache

“…9.3% had scaling less than 5, suggesting that brain tumour-associated headache is a moderate to severe intensity type which is consistent with previous studies (Forsyth and Posner, [1] Pfund et al, [2] Schankin et al, [3] Valentinis et al [4] ) All the patients required analgesics for relieving their headache, some patients with tumourassociated oedema were benefitted from steroids.…”

“…The intensity of the headache has association with the size of the tumour which is significant (p=0.000). Valentinis et al [4] have stated that within similar pathologies, increased size was associated with increased risk of headache, but other studies (Pfund et al 1999 [2] ; Levy et al [7] ; Schankin et al [3] ) have not shown this association. More number of patients with mild, moderate and severe oedema had more intense headaches than patients with no oedema.…”

“…But previous studies have shown as follows: Forsyth and Posner [1] -48%, Pfund et al [2] -58.8%, Schankin et al [3] -60%, Valentinis et al 2010 [4] -47.6%. About 11.5% (5.29% males and 6.25% females) did not have headache during the course of illness till the time of interview.…”

“…And 20% reported headache exacerbation by Valsalva manoeuvres, about a third of patients have nocturnal or morning headaches or both. (Forsyth and Posner, [1] Pfund et al, [2] Schankin et al, [3] Valentinis et al [4] ) 42.8% had features of raised intracranial tension. All the patients in the no-headache group with tumour did not have raised intracranial pressure.…”

“…But in contrast, other previous studies had stated headache lateralisation predicted tumour location in only one third of patients (Pfund et al 1999 [2] ). Frontal headaches were the most unreliable in predicting tumour location and were most common (Valentinis et al 2010 [4] ).…”