Headaches

Approved by the Cancer.Net Editorial Board, 03/2017

Almost everyone gets a headache from time to time. There are 2 main types of headaches:

Primary headaches. Primary headaches include migraines, cluster headaches, and tension headaches. Tension headaches are also called muscle contraction headaches.

Secondary headaches. Secondary headaches are caused by other medical conditions or underlying factors. These factors may include a brain tumor, head injury, infection, or medicines.

Primary headaches and secondary headaches are common in people with cancer.

Relieving side effects is an important part of cancer care and treatment. This is called palliative care or supportive care.

Headache symptoms

Headaches may have different symptoms. These factors help describe them:

Timing. This is the time of day when you develop a headache. Sometimes, the timing of a headache provides a clue to its cause. For example, headaches later in the day are often tension headaches.

Frequency. This is how often you have a headache. For example, occasionally, weekly, or daily.

Triggers. These are the factors that start a headache. Triggers can include exposure to cold, blinking lights, loud noises, or specific foods.

Duration. This is how long the headache lasts. It may range from minutes to hours to days. Some headaches start and end very suddenly. Others come and go over several hours or days.

Location. This is the place where the pain occurs. For example, pain may develop in these places:

  • Over the eyes

  • In the forehead or temples

  • At the back of the neck

  • On one side of the head

Severity. This is the degree of pain. It may range from mild to severe and incapacitating. Incapacitating means that you have difficulty moving or speaking during the headache. Some headaches start with mild pain that gradually becomes severe. Other times, they start with severe pain and remain that way.

Quality. This is the type of pain. You may describe it with some of these words:

  • Throbbing

  • Stabbing or piercing

  • A feeling of pressure

  • A dull ache

In addition to the headache itself, you may experience symptoms related to the headache:

  • Nausea and vomiting

  • Dizziness

  • Blurred vision

  • Sensitivity to light or noise

  • Fever

  • Difficulty moving or speaking

  • Pain that increases with activity

Consider keeping a headache diary to track these symptoms. This will help your doctor diagnose and treat your headaches.

Causes of headaches

The following factors can cause a headache:

Cancer. Certain cancers may cause a headache, particularly these types:

  • Cancers of the brain and spinal cord

  • Pituitary gland tumors

  • Cancer of the upper throat, called nasopharyngeal cancer

  • Some forms of lymphoma

  • Cancer that has spread to the brain

Infections. Sinusitis and meningitis can cause headaches. Sinusitis is an infection of the sinuses. These are hollow passages in the bones around the nose. With meningitis, the protective membranes covering the brain and spinal cord swell.

Cancer treatment. The following cancer treatments can cause headaches:

  • Some types of chemotherapy, such as fluorouracil (5-FU, Adrucil) and procarbazine (Matulane)

  • Radiation therapy to the brain

  • Immunotherapy, a treatment that boosts the body's natural defenses to fight cancer

Other medicine. Medicine for cancer-related symptoms or other conditions can cause headaches:

  • Antibiotics, used to treat infections

  • Antiemetics, used to prevent or treat vomiting

  • Heart medicine

Cancer-related side effects or other conditions. Symptoms or side effects related to cancer or cancer treatment can also cause headaches:

  • Anemia, a low red blood count

  • Hypercalcemia, a high level of calcium

  • Thrombocytopenia, a low platelet count

  • Dehydration, a loss of too much water from the body. This may result from severe vomiting or diarrhea.

Other factors. Stress, fatigue, anxiety, and sleeping problems may also cause headaches.

Diagnosing headaches

Your doctor will assess your symptoms and medical history. He or she will also conduct a physical exam. This information will help determine the headache type and cause.

Tell your doctor if you have headaches with these features:

  • They are frequent or severe.

  • They wake you at night.

  • They have new patterns or a change in frequency.

  • They are new or exhibit new symptoms.

Your doctor may also order tests to help diagnose the cause of your headaches:

  • Blood tests

  • A computerized tomography (CT) scan. This makes a 3-dimensional picture of the inside of the body.

  • Magnetic resonance imaging (MRI) of the brain. This uses magnetic fields to produce detailed images of the body.

  • Other tests, based on the headache pattern and symptoms

Treating and managing headaches

When possible, doctors treat the condition that causes the headache.

Medication

These medications may prevent and treat headaches or reduce the pain:

  • Over-the-counter pain relievers, like acetaminophen (Tylenol) and ibuprofen (Advil, Motrin)

  • Prescription narcotic pain relievers, like codeine

  • Tricyclic antidepressants

  • Triptan medications, like sumatriptan (Alsuma, Imitrex, Zecuity)

  • Steroid medications, especially for headaches caused by cancer that spreads to the brain

  • Antibiotics, if an infection is causing the headache

Tell your doctor about any over-the-counter pain medication you take.

Other strategies

The following may help reduce the number and severity of headaches:

  • Get enough sleep.

  • Eat well.

  • Reduce stress.

Additionally, complementary medicine may help relieve and prevent headaches. Complementary medicine techniques include:

  • Acupuncture, the use of fine needles placed in specific points of the body

  • Massage

  • Visual imagery

  • Relaxation

Talk with your health care team about controlling your headaches with complementary medicine.

Related Resources

Coping with Cancer

Managing Stress

Evaluating Complementary and Alternative Therapies