Headache or Tumor


I don’t think I know anyone who can say they’ve never had a headache.  And some have them often enough that they’re given about as much attention as a hiccup or a sneeze.  But sometimes, a headache can be more than a headache.

I was in Minneapolis doing a rotation in neurology through a university headache clinic. A lot of people were referred through primary care physicians and some even from other neurologists.  They were strange headaches to them, but headaches that were frequently seen by these university neurologists in Minneapolis.

I remember seeing a professional football player who had cluster headaches with such intense pain that it brought him to tears.  There were many middle aged and older people, but there’s one girl I remember in particular. She was 23 years old and was given to me to see with no pre-screening.

I can still recall her neurological exam and it was not very perfect.  She was a little weaker on the left than on the right but she seemed beyond a stroke of the cardiovascular sort.  Sometimes there’s just a little asymmetry in people, anyway.  I remember trying to look at the fundus with the opthalmoscopetaking that tiny but bright shock of light and putting it into her eye.  I even went so far as to give her medication to dilate her pupils.  The back of her eye, where the optic nerve came into the retina, was a tad swollen on her left side.  Indeed, she said she saw less well there.

The headache she discussed was acute and associated with vomiting.  Vomiting, of course, can be associated with migraine but there were some peculiar things about her headaches.  They would wake her up about four or five in the morning and again about five in the evening. They were always in exactly the same part of her head — not above or below but always in the front of her temple on the left.

I was concerned and sent for an MRI on an emergency basis because I had a feeling she would be a surgical candidate for a brain tumor.  And she was.

In the world of headaches, this is an extremely common complaint of which about 95 percent are incredibly benign.  Even in a place like a university neurology clinic, the tension headache is the most common culprit. So the question becomes one that is even more acute now than it was then.  How do you tell when a headache is serious enough?

You have to do an MRI to see if someone is a brain tumor candidate and if you can cure it.  Yes, I did say cure.

This young lady went to surgery and she did just fine.  But as for the general consideration of headaches, how do you pull out the brain tumors?  And of course, there are the very serious and painful headaches — like cluster headaches and migraines — which although less frequent, certainly need to be taken more seriously than the tension headache and the overall benign headaches.

This is just a little bit about how you classify and treat headaches.  Remember, it is just a little bit.  Everything has exceptions and if there is the slightest doubt, your headache may be an exception.  It must be reviewed by a doctor.  The potential consequences are too great for it to be otherwise.

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October 4, 2012

Carole @ 1:14 pm #

Hello Dr. Goldstein,

We recently met at The Bell Lounge.

Thank you for this awesome article about headaches. I have been in the throws now for about 10 days..longest one ever on the left side of my head and below my ear really bad. No ear infection. Dr wants to start me on Prednisone. I feel dehydrated due to the exhaustion of the pain so i sleep alot right now. I will now probably go back and see the Dr on Sat and ask him to order an MRI because this IS just as you explained it..I haven’t thrown up yet but no appetite and very nauseating. Thank you for this place.
Carolina Keys (Carole Seymour)

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