Brain Tumor and Tension Headaches

by Carlo Raj, MD

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    00:01 Let’s take a look at brain tumors, part of your chronic headache manifestation.

    00:08 There’s no classic headache syndrome that defines a tumor, or even a mass.

    00:13 So, it’s about suspicion, and that could be a little dangerous because not everyone, not all doctors are going to be as astute as you are.

    00:23 Typically of insidious onset, though could be sudden.

    00:27 Be careful with hemorrhage, right? May be diffuse or localized, but localization does not necessarily imply tumor location.

    00:35 That’s important.

    00:37 May be worse in the morning or waken patient at night due to raised ICP, intracranial pressure.

    00:44 Focal deficit may be present, and obviously, imaging must be done initially.

    00:55 Tension headaches.

    00:56 Most common variety of headache is this.

    00:59 May limit but not prohibit activities.

    01:02 Usually, bilateral, often with occipital, temporal, frontal band.

    01:09 You wear a band around your head if you’re running, exercising.

    01:12 That’s what this particular description is, bandlike predominance.

    01:17 Typically dull and aching, but pressure is not infrequent.

    01:22 Onset is more gradual than with migraine.

    01:25 Remember, migraine, even though it’s a chronic headache, we’re talking about 30 minutes in which all of a sudden, it becomes very, very intolerable.

    01:34 Here, with tension, it’s more gradual.

    01:39 Mild nausea may be present.

    01:42 Associated symptoms are absent or mild.

    01:44 Neurologic exam, actually, unremarkable.

    01:47 And here, it’s important that you pay attention to tenderness in the cervical paraspinal or temporalis muscle, may be seen but is not common nor diagnostic.

    01:59 Just keep that in mind as being, perhaps, a presentation that you’ll be given.

    02:08 Typically respond to your Tylenol, Advil, Aleve.

    02:14 OTC stands for over-the-counter analgesics.

    02:17 Clear? Tension headaches.

    02:19 This is when you start worrying about this patient who becomes addicted to such over-the-counter medication, just because we say over-the-counter, you know that the number one cause of some of these issues in the liver in such, or kidney.

    02:35 It could be some of these NSAIDS or acetaminophen.

    02:40 Cautious use of OTC, absolutely, must be exercised.

    02:46 Opioids should be avoided because once again, this is how the patient is going to develop addiction, and this is a huge problem in our society.

    02:55 You have far too many doctors who wish to take care of the patient by negligibly administering opioids and not understanding or not wishing to accept the addictive nature of it.

    03:09 IV ketorolac effective for severe episodes.

    03:13 And ergotamines are not effective here.

    03:16 In migraines, ergotamines might be given, but remember, you’re worried about gangrene as being a possible adverse effect.

    03:23 Now, without the treatment, tends to persist for days, often recurring after walking each morning, and worsening during late afternoon or evening.

    03:34 There’s a recurrence after walking each morning, and worsening during later afternoon or evening.

    03:40 Welcome to tension headache, not a good place to be.

    03:46 Management: Prophylactically, tricyclics, such as amitriptyline.

    03:49 Beta blockers are not particularly helpful.

    03:52 In migraines, quite or could.

    03:57 Treat underlying anxiety and depression really is what it comes down to.

    04:00 These patients tend to be stressed out about something, huh? And for each individual, now this is where it becomes interesting, is the fact that we all have different threshold for stress.

    04:10 Some of us, even the little bit of “anxiety” is enough of a threshold in which the patient develops tension headache.

    04:19 For others, the threshold is limitless.

    04:23 So, you want to be quite familiar with the psychology of your patients.

    04:28 Psychotherapy is the most effective because you’re looking for that underlying stress that the patient doesn’t even know that he or she is experiencing, and it could be something, just driving or work, relationships, whatever it may be, but this oftentimes, will be helpful in refractory cases.

    About the Lecture

    The lecture Brain Tumor and Tension Headaches by Carlo Raj, MD is from the course Headache. It contains the following chapters:

    • Brain Tumor
    • Tension Headaches

    Included Quiz Questions

    1. Tension headache
    2. Migraine headache
    3. Cluster headache
    4. Subdural headache
    5. Meningitis headache
    1. Dihydroergotamine
    2. IV ketorolac
    3. Tylenol
    4. Lifestyle modification
    5. Aleve
    1. Tension headache is more gradual in onset, and there may be tenderness in the paraspinals and temporalis muscles.
    2. Tension headache is more sudden in onset, and there may be tenderness in the paraspinals and temporalis muscles.
    3. Tension headache is more gradual in onset, and there will be tenderness in the paraspinals and temporalis muscles.
    4. Tension headache responds to ergotamine more frequently.
    5. Tension headache presents with photophobia and neurological symptoms.

    Author of lecture Brain Tumor and Tension Headaches

     Carlo Raj, MD

    Carlo Raj, MD

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