Hematology-Oncology Department (Neuro-Oncology), Tufts Medical Center, Boston, MA, USA.
Headache. 2014 Apr;54(4):772-5. doi: 10.1111/head.12317. Epub 2014 Mar 13.
Headaches occur commonly in all patients, including those who have brain tumors. Using the search terms "headache and brain tumors," "intracranial neoplasms and headache," "facial pain and brain tumors," "brain neoplasms/pathology," and "headache/etiology," we reviewed the literature from the past 78 years on the proposed mechanisms of brain tumor headache, beginning with the work of Penfield.
Most of what we know about the mechanisms of brain tumor associated headache come from neurosurgical observations from intra-operative dural and blood vessel stimulation as well as intra-operative observations and anecdotal information about resolution of headache symptoms with various tumor-directed therapies.
There is an increasing overlap between the primary and secondary headaches and they may actually share a similar biological mechanism. While there can be some criticism that the experimental work with dural and arterial stimulation produced head pain and not actual headache, when considered with the clinical observations about headache type, coupled with improvement after treatment of the primary tumor, we believe that traction on these structures, coupled with increased intracranial pressure, is clearly part of the genesis of brain tumor headache and may also involve peripheral sensitization with neurogenic inflammation as well as a component of central sensitization through trigeminovascular afferents on the meninges and cranial vessels.
头痛在所有患者中都很常见，包括患有脑肿瘤的患者。我们使用了“头痛和脑肿瘤”、“颅内肿瘤和头痛”、“面部疼痛和脑肿瘤”、“脑肿瘤/病理学”和“头痛/病因”等搜索词，回顾了过去 78 年来有关脑肿瘤性头痛的拟议机制的文献，从 Penfield 的工作开始。
我们对脑肿瘤相关头痛机制的了解大多来自神经外科术中对硬脑膜和血管的刺激观察，以及术中对各种针对肿瘤的治疗后头痛症状缓解的观察和轶事信息。
原发性头痛和继发性头痛之间的重叠越来越多，它们实际上可能具有相似的生物学机制。虽然有人可能会批评硬脑膜和动脉刺激的实验工作引起的是头痛而不是实际的头痛，但当与头痛类型的临床观察相结合，并考虑到原发性肿瘤治疗后的改善时，我们认为这些结构的牵引，加上颅内压的增加，显然是脑肿瘤性头痛的成因之一，也可能涉及通过脑膜和颅血管的三叉神经血管传入纤维的外周致敏以及中枢致敏的一个组成部分。
