Headaches

This section has been reviewed and approved by the Cancer.Net Editorial Board, 02/2014

Key Messages:

  • Headaches are common in people with cancer, but not all headaches feel the same or have the same cause.
  • Determining the type and cause of a headache based on your symptoms, medical history, and a physical examination will help your doctor find the best way to treat your headache.
  • Some headaches can be managed by treating the condition that causes them. Medications approved by your doctor may be helpful for preventing and treating headaches.

Almost everyone gets an occasional headache. Headaches are generally divided into two main categories: primary headaches and secondary headaches. Primary headaches include migraines, cluster headaches, and tension headaches. Tension headaches are also known 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. Both primary and secondary headaches are common in people with cancer.

Relieving side effects, also called symptom management, palliative care, or supportive care, is an important part of cancer care and treatment. If you are concerned about headaches, talk with your doctor or another member of your health care team.

Symptoms

Not all headaches are the same. Headache symptoms are described by several characteristics:

  • Timing refers to the time of day when the headache occurs. Sometimes, the timing of headaches provides a clue to the headache's cause. For example, headaches that occur later in the day are often tension headaches.
  • Frequency refers to how often the headache occurs, such as occasionally, weekly, or daily.
  • Triggers refer to the factors that bring on a headache, such as exposure to cold, blinking lights, loud noises, or specific foods
  • Duration refers to how long the headache lasts, ranging from minutes to hours to days. Some headaches start and end very suddenly. Others come and go over several hours or days.
  • Location refers to where the pain is occurring, 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, which means you have difficulty moving or speaking during the headache. Some headaches start with mild pain that gradually becomes more severe. In other cases, the severity of the pain remains constant.
  • Quality refers to the type of pain experienced, such as throbbing, stabbing, piercing, pressure, or a dull ache.

In addition to the headache itself, you may experience additional symptoms related to the headache. These include nausea, vomiting, dizziness, blurred vision, sensitivity to light or noise, fever, difficulty moving or speaking, and pain that increases with activity.

Causes

Headaches may be caused by the following factors:

  • Cancers, including primary cancers of the brain, and spinal cord, pituitary gland tumors, nasopharyngeal cancer (upper throat cancer), some forms of lymphoma, and cancer that has spread to the brain.
  • Infections, such as sinusitis and meningitis. Sinusitis is an infection of the hollow passages in the bones of the head, called the sinuses. Meningitis is the swelling of the protective membranes covering the brain and spinal cord.
  • Some types of chemotherapy, such as fluorouracil (5-FU, Adrucil) and  procarbazine (Matulane)
  • Other medications, such as some antibiotics, drugs called antiemetics that help prevent or treat vomiting, and heart medications
  • Radiation therapy to of the brain
  • Immunotherapy. Also called biologic therapy, this type of treatment is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to bolster, target, or restore immune system function.
  • Other conditions or symptoms related to cancer or cancer treatments, such as:                       
  • Stress, fatigue, anxiety, and insomnia (difficulty sleeping) may also cause an increase in headaches

Diagnosis

Tell your doctor or another member of your health care team if you are experiencing frequent or severe headaches, if the headache wakes you at night, if you notice a change in the pattern or frequency of existing headaches, or if the headaches are new and associated with other symptoms.

Your doctor will determine the type and cause of a headache based on your 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, or magnetic resonance imaging (MRI) of the brain, or other tests based on the pattern and associated symptoms. A CT scan makes a three-dimensional picture of the inside of the body and an MRI uses magnetic fields to produce detailed images of the body.

Treatment and management

When possible, headaches caused by an underlying condition, such as an infection, are managed by treating the condition that causes the headache. Medications may be used to treat headaches or reduce the pain, but it is important to get your doctor's approval before taking some over-the-counter pain medications. Medications that are commonly are used to both treat and prevent headaches include:

  • Over-the-counter pain relievers, such as acetaminophen (Tylenol) and ibuprofen (Advil, Motrin)
  • Prescription narcotic pain relievers, such as codeine
  • Tricyclic antidepressants
  • Triptan medications, such as sumatriptan (Alsuma, Imitrex, Zecuity)
  • Steroid medications, especially to treat headaches caused by the spread 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 have found that complementary medicine helps relieve and prevent headaches. Complementary medicine techniques include acupuncture, which is the use of fine needles in specific points of the body to relieve pain, massage, visual imagery, and relaxation. Talk with your doctor or other member of your health care team about controlling your headaches with complementary medicine.

More Information

Side Effects

Questions to Ask When Considering Complementary or Alternative Medicine