If I Have Consistent Migraines, Is There Any Fear of Something Worse Like a Brain Tumor?

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Typically brain tumor does not cause headache, it causes seizures, because brain tumors and the brain tissue itself, you don't have pain receptors in the brain tissue which is why you might have seen programs on TV, where they're performing brain surgery and the patient is awake, and they're poking around in the brain.

So you typically don't really feel brain tumor, but the pressure of the brain tumor can cause seizures. That said occasionally brain tumors can cause headache, certainly aneurysms can cause headache. So how do you decide whether this is potentially a benign migraine or something that we call secondary headache, which is where something structural cause a headache.

Well, they've studied this and they found that in a patient who meets criteria for migraine meets diagnostic criteria and they have a normal neurological exam. The chance that there is anything dangerous causing their headaches is less than 1%, which is the same as the general population.

If you were to scan 100 patients without headache, less than 1% of the time you'd find it's their tumor. So it's not typically recommended that these patients get any imaging because that doesn't change their management. Red flags for me meaning circumstances where I'm concerned that this is not migraine are not just if the patient doesn't meet criteria for migraine, but if they come in and they say, well actually what teach my residents is it's the first, the worst or the cursed.

If it's the first headache they've ever had and they're outside of the teenage where migraine typically starts. Let's say they're at 40 and they just start having headaches, that's concerning that there might be something else going on. If it's the worst headache of their life, that can sometime signify bleeding in the brain so that those patients also should be imaged.

Or if its cursed meaning that the patient had cancer or HIV or some other concerning diagnosis that could raise the possibility of an infection or tumor in the brain as well as if they have an abnormality in their neurological exam that's how you kind of group cursed together.

So those are circumstances where you would want to do imaging..