Is It a Headache or Brain Tumor? When to See a Doctor for Headaches

Most of us have suffered from headaches, which are the most common form of pain, according to the U.S. National Institute of Neurological Disorders and Stroke (NINDS).

Dr. Anne Damian Yacoub, the co-director of the Johns Hopkins Headache Center and an assistant professor of neurology at Johns Hopkins, told Newsweek: "A headache is both a common symptom of multiple medical conditions, but also a diagnosis in itself. Any new kind of headache should typically be at least discussed with your primary care physician."

Not all headaches require immediate medical attention but some can be a sign of a more serious health issue, as seen in a viral post shared on Reddit. User TofuBoy22 said a headache they had for six months turned out to be a brain tumor, which is an abnormal growth of tissue found inside the skull.

The Redditor said their headache started off mild but was "always in the same place above the left eye and round to the back of the head behind the left ear."

They had an MRI scan done, which showed a brain tumor and "after about a week, I was quickly admitted into the [U.K.] National Hospital for Neurology and Neurosurgery in London where over the next 10 days, I had two surgeries," they said in an update shared in another Reddit post.

Brain tumors can be benign or malignant. The tumor is given a numbered score which reflects its rate of malignancy. "This score can help doctors determine how to treat the tumor and predict the likely outcome, or prognosis, for the individual," explains the NINDS.

When Does a Headache Require Emergency Medical Care?

The presence of certain conditions and symptoms suggests "the possibility that the headache is a symptom of a serious cause" and prompts a more urgent evaluation, Dr. Mark Malkin from the Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center at the Cleveland Clinic, told Newsweek.

These conditions include, but are not limited to, the following, as outlined by Yacoub and Malkin:

• Onset of the headache in childhood, or in or after middle age.
• A recent onset and progressive course of the headache.
• A new headache after the age of 50 or in young children.
• A personal history of cancer or immunosuppression or headaches in pregnant patients.
• A headache associated with symptoms (such as fevers, chills, night sweats, weight changes, pain or numbness of the jaw with chewing).
• A headache associated with any neurological symptoms or other general symptoms (such as numbness, tingling, weakness, vision loss, double vision, seizures, vomiting and excessive lethargy).
• A headache that reaches its peak intensity in less than a minute.

Yacoub said: "It can be difficult for patients who have a long history of headaches to know when they should be reassessed. I would say that an increase in headache frequency or change in the quality of the headache should prompt another visit with your physician."

Malkin said that for any of the aforementioned serious symptoms associated with headaches, you should see a neurologist who will assess the following questions:

• Does the headache fail to conform readily to an innocuous pattern (like tension headache or migraine)?
• Does the patient "look sick" or "not right"?
• Are there abnormal signs on neurological or general examination?
• Are there signs of irritation of the meninges (the thin, transparent covering of the brain)?

"Based upon all of the above, an MRI [magnetic resonance imaging] of the brain or blood tests, may be indicated to more completely evaluate the situation," Malkin said.

Does a Benign Brain Tumor Need to Be Removed?

Yacoub said brain tumors can either primarily originate from the brain, or be a "metastasis [a malignant growth] from another cancer elsewhere in the body."

Malkin said: "Tumors that arise within the brain are rarely truly benign. Benign implies that, once discovered, it never grows or, once removed, it never grows back."

Yacoub said benign brain tumors are quite diverse and determining whether a brain tumor should be removed depends on the location of the tumor in the brain, as well as its potential for growth and spread.

The most common benign brain tumor is a "Grade 1 meningioma," which actually arises between the brain and the skull, rather than from within the brain per se, he said.

The vast majority of meningiomas occur spontaneously and we do not know the cause of them. "Rarely, previous exposure to ionizing radiation to the head (for example, to treat childhood leukemia) results in the development of a meningioma (or multiple meningiomas) many years, even decades, later," Malkin noted.

Meningiomas don't need to be removed if they are small and "not causing symptoms, not causing pressure within the brain and not enlarging over time," he said.

When Is a Brain Tumor Life-Threatening?

Malkin said there is "a real cause for worry" if a brain tumor is causing unremitting symptoms, significant neurological signs or there's evidence on an MRI scan that it could be malignant (such as the distortion of surrounding brain structures).

Yacoub said brain tumors can at times be life-threatening. Sometimes even benign tumors require removal because of the compression they cause on important brain structures. "These management decisions are typically made by a neurosurgeon or a neuro-oncologist."

Treatment decisions are made based on the type of tumor, how aggressive it is likely to be, as well as the location of the tumor, she said.

Malkin said treatment options for brain tumors include surgery, radiation therapy and drug therapy, including chemotherapy, non-chemo drug therapy and immunotherapy (either an activation or suppression of the immune system).

For more information on headaches and brain tumors, see the website of the National Institute of Neurological Disorders and Stroke.