Departments of Neurology, Tufts Medical Center, Boston, MA, USA.
Headache. 2014 Apr;54(4):776-85. doi: 10.1111/head.12326.
Headaches occur commonly in all patients, including those who have brain tumors. It has been argued that there is a classic "brain tumor headache type" - defined by the International Headache Society as one that is localized, progressive, worse in the morning, aggravated by coughing or bending forward, develops in temporal and often spatial relation to the neoplasm, and resolves within 7 days of surgical removal or treatment with corticosteroids.
Using the search terms "headache and brain tumors," "intracranial neoplasms and headache," and "facial pain and brain tumors," we reviewed the literature from the past 20 years on brain tumor-associated headache and reflected upon the International Classification of Headache Disorders-3 (ICHD-3). In a separate, complementary paper, the proposed mechanisms of brain tumor headache are reviewed.
We discuss multiple clinical presentations of brain tumor headaches, present the ICHD-3 diagnostic criteria for each type of headache, and then apply our findings to the ICHD-3. Our primary and major finding was that brain tumor headaches can present similarly to primary headaches in those with a predisposition to headaches, suggesting that following ICHD-3 criteria could cause a clinician to overlook a headache caused by a brain tumor. We further find that some types of headaches are not explicitly discussed in the ICHD-3 and also propose that the International Headache Society formally define SMART (Stroke-like Migraine Attacks after Radiation Therapy) syndrome given the increasing amount of literature on this disorder.
Our literature review revealed that brain tumor headache uncommonly presents with classic brain tumor headache characteristics and often satisfies criteria for a primary headache category such as migraine or tension-type. Thus, clinicians may miss headaches due to brain tumors in following ICHD-3 criteria, and the distinction between primary and secondary headache disorders may not be so clear-cut.
头痛在所有患者中都很常见，包括那些患有脑肿瘤的患者。有人认为存在一种典型的“脑肿瘤头痛类型”——国际头痛协会将其定义为局限性头痛、进行性加重、早晨更严重、咳嗽或弯腰时加重、与肿瘤在时间上常常有空间关系、并在手术切除或皮质类固醇治疗后 7 天内缓解。
使用“头痛与脑肿瘤”、“颅内肿瘤与头痛”和“面部疼痛与脑肿瘤”等搜索词，我们回顾了过去 20 年与脑肿瘤相关头痛的文献，并思考了国际头痛分类第三版（ICHD-3）。在另一篇独立的补充论文中，回顾了脑肿瘤头痛的提出机制。
我们讨论了脑肿瘤头痛的多种临床表现，提出了每种头痛类型的 ICHD-3 诊断标准，然后将我们的发现应用于 ICHD-3。我们的主要发现是，脑肿瘤头痛在易患头痛的患者中可能与原发性头痛表现相似，这表明遵循 ICHD-3 标准可能导致临床医生忽视由脑肿瘤引起的头痛。我们进一步发现，一些类型的头痛在 ICHD-3 中没有明确讨论，也建议国际头痛协会正式定义 SMART（放疗后类似中风的偏头痛发作）综合征，因为关于这种疾病的文献越来越多。
我们的文献回顾表明，脑肿瘤头痛不常表现出典型的脑肿瘤头痛特征，并且常常符合偏头痛或紧张型等原发性头痛类别的标准。因此，临床医生可能会错过遵循 ICHD-3 标准的脑肿瘤引起的头痛，原发性和继发性头痛疾病之间的区别可能并不那么明显。
