One of the most common early symptoms of a brain tumour can be headache. Headaches before a diagnosis are caused by a build-up of pressure due to the tumour and swelling of tissues in the brain. Headaches that are caused by this build-up of pressure are often worse in the morning. They may improve soon after getting up, but may get worse on bending over. Headaches from brain swelling (‘cerebral oedema’) may be associated with nausea or even morning vomiting.
Fortunately, once a diagnosis has been made, surgery and other medications to treat the tumour and relieve swelling should make this type of headache less common. If your friend or relative is experiencing persistent headache, particularly worse in the morning or with nausea and vomiting, it is important to seek advice from the doctor, neuro-oncology nurse or your care co-ordinator. There are many other reasons why people with a brain tumour can experience headache:
Tension-type headaches
These are usually described as a dull-ache on both sides of the head but may be worse on the side of the tumour. They are often worse at the end of the day, or when stressful events are expected (e.g. MRI results).
Anti-nausea treatments
Medications such as Ondansetron (Zofran) or Granisetron (Kytril) are anti-nausea treatments, but can cause headache as a side effect. These headaches would only be experienced on days the tablets are taken.
Dehydration
Sometimes people who are unwell or less mobile, or people with a frontal lobe affected, may not drink enough water. This may also happen in hot weather, or if people have trouble getting to the toilet. Encourage your friend or relative to drink plenty of fluids.
Postoperative pain
People who have had an operation on the brain can have some discomfort or pain over the operation site for some time, even some years. In this case, pain may be worse on touching or pressing the operation site
Treatment
Try simple measures such as fluids and paracetamol in the first instance. If headache is a major ongoing problem, doctors will assess and prescribe stronger medication if necessary.
Non-prescription non-steroidal anti-inflammatory medications such as ibuprofen (brand names include Brufen® and Nurofen®) are best avoided unless recommended by a doctor, as they can interact with other medications such as dexamethasone.
For headaches caused by brain swelling, dexamethasone is the main treatment. The dose is increased until the pain is controlled, but kept as low as possible to minimise side effects. (There is more information about treatment for this type of headache in the section ‘Dealing with the treatment’).