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Know Your Pain: Brain Tumor

Know Your Pain: Brain Tumor

You’ve probably been there before. You had a sudden, excruciating headache, and you rushed to the computer to Google “brain tumor,” fearing the worst.

Connie Gray Prigg, 47, of Baltimore, Md., has been there. It was around the time of Thanksgiving in 2008 when Prigg was at work. After she lifted a heavy box off the floor, she experienced a surging headache. She’d had headaches her whole life, but this felt different. So she Googled the worst case scenario, and then visited her primary care physician. Following an MRI, the physician told Prigg she had a brain tumor and suspected it was a benign meningioma—a non-cancerous tumor in the brain.

But Prigg’s case isn’t typical. Generally headache alone is not enough to signal a brain tumor—and brain tumor is rare. “If you take all the patients with headache, less than one in 100 will have brain tumor,” said Vincent T. Martin, MD, professor of medicine at the University of Cincinnati. “I’ve been in a headache clinic for 17 years and have only seen a handful of malignant brain tumors.”

To determine whether you should ask your physician to evaluate you for brain tumor, it is important to understand the symptoms.

Recognize Your Symptoms

Classic symptoms of brain tumor include:

Seizure: Someone with no prior history of seizure who suddenly has seizures should see a physician to rule out brain tumor, says Henry Brem, MD, neurosurgeon-in-chief at The Johns Hopkins Hospital in Baltimore, Md. Seizure is an early warning sign and could help physicians identify the tumor before it’s grown to a damaging size.

Neurological complications: Loss of vision, double vision, weakness on one side of the body, facial weakness and speech problems could suggest a neurological abnormality, says Dr. Martin, and this warrants a medical evaluation to exclude a brain tumor.

Increased intra-cranial pressure: “This is less common and is manifested by headache, nausea, vomiting and, at later stages, decreased mental function,” says Dr. Brem. That requires an urgent evaluation because it means there could be increased pressure in the brain, a signal that the tumor may have already progressed, Dr. Brem says.

If headache does manifest at a later stage in brain tumor development, it will likely show up as an exertion headache (e.g., head pain when you cough or jump), new onset headache if you’re over age 50, a nighttime headache or a morning headache. And it will get progressively worse over time. “They generally don’t just come and go,” says Dr. Brem.

But, Dr. Martin warns, these headaches could be caused by a number of other factors and do not signal brain tumor on their own. “It’s very unusual to have a brain tumor without any abnormal neurologic signs or seizure disorder,” Martin says.

Understand the Causes

So how does a brain tumor come about? According to Dr. Brem, researchers have found some causes of brain tumor including carcinogens and high doses of radiation. Brain tumors are also more common in someone with a history of cancer in other parts of the body, as it could have spread to the brain.

But common fears about cell phones are unfounded.

“There’s not a shred of evidence that cell phones cause brain tumors,” says Dr. Brem. “There was a study once that showed you get warming of the brain, but you know that anyway: It’s hot in your hand, it’ll get hot by your head. That doesn’t mean it will lead to brain tumor.”

Find Relief

Treatment for malignant (cancerous) tumors usually involves removing as much of the tumor as is safe to do, then following up with chemotherapy, chemotherapy implants, radiation therapy and/or medication. Though the outlook is generally bad for brain cancer, Dr. Brem says the average survival has doubled in recent years. Research has shown that today, 1 in 5 of patients diagnosed with malignant brain tumor are alive a year later; thirty years ago, fewer than 1 in 10 were alive six months after diagnosis.

If a tumor is benign, physicians may recommend removing it—or they may suggest leaving it in place and monitoring it to make sure it doesn’t grow and become cancerous. Dr. Brem, who served as Prigg’s neurosurgeon, gave her the option to leave it in place.

“I’m one of those people that, once I know I have something, I think I’m better off not having it,” said Prigg.

Brem also warned Prigg that her tumor was close to the superior sagittal sinus, an area that allows blood to drain from the brain. He said that if the tumor were to grow and intertwine with the blood vessel, it would be more difficult to remove down the road. So Prigg opted to have the tumor removed right away.

Prigg continues to have an MRI every six months to make sure the tumor hasn’t come back, and she still has headaches.

“But I was grateful to that persistent exertion headache,” she says. “It led me to talk to my primary care doctor and helped to roll out my treatment.”

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