Headache in Brain Tumors and Gliomas: A Comprehensive Review of Pathophysiology, Clinical Features, Diagnosis, and Management
DOI:
https://doi.org/10.63666/ejsmr.1694-9013.4.I.2026.104Keywords:
brain tumor, glioma, headache, intracranial hypertension, glioblastoma, astrocytomaAbstract
Background: Headache is among the most frequently reported symptoms in patients harboring intracranial tumors, including gliomas of all WHO grades. Despite its prevalence, the characteristics, pathophysiology, and optimal management of tumor-associated headache remain incompletely understood and are often overshadowed by the oncological focus of care.
Objectives: This review synthesizes current evidence on the pathophysiology, clinical features, diagnostic evaluation, and management of headache in patients with primary brain tumors, with particular emphasis on gliomas spanning WHO grades I through IV, including pilocytic astrocytoma, low-grade diffuse astrocytoma, anaplastic astrocytoma, and glioblastoma (GBM).
Methods: A narrative review of peer-reviewed literature was conducted using PubMed, MEDLINE, Scopus, and the Cochrane Database. Publications from 1990 to 2024 were considered, with priority given to prospective cohort studies, systematic reviews, and authoritative guidelines including ICHD-3 and the 2021 WHO CNS tumor classification.
Results: Headache occurs in approximately 36–60% of brain tumor patients, with the highest prevalence and severity in GBM and posterior fossa tumors. The classic early-morning headache is present in fewer than one-third of patients; most tumor-associated headaches resemble tension-type or non-specific headache. Pathophysiological mechanisms include raised intracranial pressure, meningeal traction, vasogenic peritumoral edema, and neuroinflammatory sensitization. Headache characteristics differ meaningfully across tumor types as documented in literature reviews of GBM, astrocytomas, and pilocytic astrocytoma. Management requires integration of corticosteroids, analgesics, neurosurgical resection, and palliative care; extent of resection independently influences headache outcomes and survival.
Conclusion: Tumor-associated headache requires systematic evaluation with neuroimaging and an individualized, multidisciplinary management strategy encompassing the full disease trajectory.
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