'Headache may be only symptom of brain tumour'

Headache could be the only symptom of brain tumour in many cases, say researchers, suggesting that CT scans and other neuro-imaging tests for people with headache could prove to be helpful tools in spotting the deadly disease.

The suggestions come in view of recent proposed guidelines in the US seeking to reduce the use of neuro-imaging tests for patients with headaches, as part of initiatives to limit the use of unnecessary and costly medical tests.

"Although the intentions are laudable, these guidelines are inconsistent with the neurosurgeon's experience with patients with brain tumour," said Ammar H. Hawasli from Washington University' School of Medicine in the US.

"Specifically, patients with brain tumours may present with isolated headaches in the absence of other neurological symptoms and signs," added Hawasli.

To illustrate the point, the researchers analysed 95 patients with a confirmed diagnosis of brain tumour.

They found that in 11 patients, headache was the only symptom of brain tumour. Four of these patients had "new-onset" headaches that would have qualified them for neuro-imaging under the recently proposed guidelines.

The remaining seven patients had migraine or other types of headache for which imaging may not have been performed under the proposed "choosing wisely" guidelines of ABIM (American Board of Internal Medicine) Foundation, the researchers said.

Therefore, neuro-imaging would have been delayed or never performed in three to seven percent of patients with brain tumours.

"We support careful and sensible use of neuro-imaging in which physicians exercise excellent clinical judgment to reduce waste in the medical system," Hawasli said.

The study appeared in the journal Neurosurgery.