Secondary Primary Headache Syndromes in Patients with Glioma (P07.019)

OBJECTIVE: To describe the author9s experience with managing primary headache syndromes in patient with glioma. BACKGROUND: Headache is a common presentation of glioma, characteristically due to raised intracranial pressure (ICP) and is usually not confused with primary headache syndromes. However, we have observed glioma patients, with both low grade and high grade tumours who appear to have migraine-like headaches that can be a difficult management issue, leading to misuse of corticosteroids and misplaced concerns about tumour progression. DESIGN/METHODS: This is a retrospective case series of patients seen over an 18 year period detailing clinical features and management approaches. RESULTS: A number of patterns were seen in this group of patients. Pattern 1: Typical migraine headache leading to diagnosis of 9asymptomatic9 low grade glioma (LGG); Pattern 2: Patient with known migraine whose pattern changes prior to diagnosis of tumour; Pattern 3: Migraine like headaches occurring following radiotherapy leading to inappropriate steroid use; Pattern 4: intractable Chronic Daily headache syndrome. Some patients responded well to standard therapies for chronic headaches (pizotifen, Amitriptyline , Beta-blocker) while others were particularly resistant to headache therapies. CONCLUSIONS: This topic is pertinent for both for neurologists and oncologists treating patients with primary brain tumours, as it may be confused with tumour progression, can be readily treated in most patients, but may also dominate the clinical picture in a small percentage of patients. Disclosure: Dr. Cher has received personal compensation for activities with Roche Diagnostics Corporation and Merck Sharp & Dohme Limited.