7.4.1 Headache attributed to intracranial neoplasm

Description:

Headache caused by one or more space-occupying intracranial tumours.

Diagnostic criteria:
  1. Any headache fulfilling criterion C
  2. A space-occupying intracranial neoplasm has been demonstrated
  3. Evidence of causation demonstrated by at least two of the following:
    1. headache has developed in temporal relation to development of the neoplasm, or led to its discovery
    2. either or both of the following:
      • a) headache has significantly worsened in parallel with worsening of the neoplasm
      • b) headache has significantly improved in temporal relation to successful treatment of the neoplasm
    3. headache has at least one of the following four characteristics:
      • a) progressive
      • b) worse in the morning and/or when lying down
      • c) aggravated by Valsalva-like manœuvres
      • d) accompanied by nausea and/or vomiting
  4. Not better accounted for by another ICHD-3 diagnosis.
Comments:

The prevalence of headache in patients with intracranial tumours ranges from 32 to 71%. Likelihood of headache is greater in young patients (including children), in patients with a history of primary headache, and with rapid growth of the tumour or posterior fossa or midline localization. A low threshold for investigation is suggested in any patient with a current or prior history of cancer.

There are no pathognomonic features of 7.4.1 Headache attributed to intracranial neoplasm, although progression or deterioration is a key feature. The other suggestive symptoms (severe, worse in the morning and associated with nausea and vomiting) are not a classical triad; they are more likely in the context of intracranial hypertension and with posterior fossa tumours.

The headache is not necessarily ipsilateral the tumour. Masses adjacent to the skull or dura mater tend to be more associated with ipsilateral headaches but intracranial hypertension produces a more diffuse headache. The headache caused by a brain tumour rarely remains the only symptom: isolated headache occurs in 2-16% of patients but neurological deficits and seizures are common.