In the US there are around 700,000 people living with a brain tumor compared to 37,000,000 people living with migraine. (1,2) Yet the symptoms are similar and easily confused. They are so similar in fact that many people with their first migraine are rushed to hospital fearing the worst.
If you experience a sudden attack where you experience pins and needles, blurred vision, colored spots and patterns, cognitive impairment, memory loss, slurred speech or even difficulty walking it will cause serious concern. Combine all this with a skull crushing headache and it’s understandable why you might rush to the hospital.
When are symptoms like this a sign of something life threatening like a brain tumor or from something else like a migraine?
Let's look first at brain tumors.
What are brain tumors?
A brain tumor occurs when abnormal cells form in the brain. In a healthy brain, cells follow a normal cycle of ageing, death and replacement by new cells. With tumors, this process is interrupted. (3)
The tumor cells continue to grow without dying even though the body doesn’t need them. As the tumor grows it takes up space within the skull and interferes with normal brain activity.
Tumors can cause damage by:
- Increasing pressure in the brain.
- Shifting the brain and causing it to push against the skull.
- Invading and damaging nearby healthy brain tissue and nerves.
Brain tumors can be benign or malignant (brain cancer).
A benign tumors are non cancerous. They are typically slow-growing and have clear borders which separate them from healthy brain tissue. Spreading is rare. Benign tumors may be found in areas of the brain which control vital life functions and may still require urgent treatment. Around 60% of brain tumors are benign. (4)
A malignant brain tumor is a cancerous tumor in the brain. Brain cancer is the same as a malignant brain tumor. These are often life-threatening tumors which grow rapidly and aggressively spread to surrounding areas in the brain and central nervous system. Less than 40% of brain tumors are found to be malignant. (4)
Brain Tumor Symptoms
Symptoms of a brain tumor can vary depending on the type of tumor and its location. Different areas of the brain are responsible for different functions of the body. The location of the tumor often affects the type of symptoms experienced.
The onset of symptoms also vary. Some tumors may have no symptoms until they are large which then led to a serious and rapid decline in health. Others may have a slow, gradual onset of symptoms over time.
What makes tumors challenging to separate from other headache disorders such as migraine is the similarity of symptoms. Most headaches are not associated with brain tumors. But, headaches are one of the most common symptoms experienced by those with brain tumors. See below chart (5) for how common certain symptoms are in those with brain tumors.
Here is a more complete list of brain tumor symptoms:
- headache or migraines
- nausea and/or vomiting
- reduced cognition and mental faculty
- difficulty speaking or remembering words
- short term memory problems
- changes in vision, hearing, smell or taste,
- loss of consciousness
- moodiness, irritability, depression or personality changes (which may only be noticed by friends or family)
- balance problems
- weakness in one part of the body
If you've had migraine for a while then you probably noticed that just about all these symptoms can be experienced with a primary migraine condition.
This is why getting an accurate diagnosis is important. Often you will need to be referred to a neurologist who specialises in this area.
In a patient who passes a normal neurological exam with no other complaints except for a recurring headache, the diagnosis is rarely a brain tumor. Below are a number of symptoms that have been identified as ‘red flags’ that may indicate something more serious.1
The cause of brain tumors is not fully understood. Researchers globally are investigating potential causes. It is understood that certain inherited conditions or genetic mutations are linked with brain tumors. These include multiple endocrine noplasia, Von Hippel-Lindau disease and neurofibromatosis type 2. (11)
Mobile phones have not been shown to cause cancer or more specifically brain cancer. Current evidence is very weak. (12) Despite over a decade of widespread mobile usage globally, there has been no upward trend observed in brain cancer incidence rates. (13)
Diagnosing brain tumors
What you can expect from your visit with the doctor is a series of questions about your symptoms as well as your personal and family health history.
Often a physical exam will be performed which includes a neurological exam. If there is reason to suspect a brain tumor, the doctor may request one or more of the following (6)
- CT (CAT) or MRI scan to see detailed images of the brain.
- Angiogram or MRA which involve the use of dye and x-rays of blood vessels in the brain to look for abnormalities.
- A biopsy may be also be performed. This is when a tissue sample of the tumor is taken often through surgery or needle and sent to the lab to test for any signs of cancer.
Treating brain tumors
If a brain tumor is discoverd, surgery is usually the first option to remove it. However sometimes the brain tumor cannot be surgically removed because of its location in the brain.
In this case chemotherapy and radiation therapy are both options for killing and shrinking the tumor. These options may also be used after surgery to kill any remaining cancer cells.
For tumors located deep in the brain Gamma Knife therapy may be used which is a relatively new form of highly focused radiation therapy. (7)
Treatments for cancer can also damage healthy tissues so it’s important to discuss all your options with your doctor. Knowing the possible side effects, long term consequences and risks are important in making an informed decision.
The odds: migraine vs brain tumor
Migraines are common. They are more common than asthma and epilepsy combined. They simply don’t get the same advocacy or support. Around 15% of the population or 37 million people in the US experience migraine. Globally around 1 in 7 people will experience migraine at some point.
Brain tumors on the other hand are rare. Just 0.2% of the population are living with a brain tumor diagnosis. There are around 70,000 new cases of any type of brain tumor being diagnosed each year in US. (8) That’s a 0.02% of the population. In other words, statically speaking, there is a 99.8% chance that you are tumor free.
My philosophy is that it’s better to be safe than sorry. If in doubt or if your worried then see your doctor.
Brain tumors can be benign or malignant. In both cases waiting longer only lets things get worse. Make an appointment and get a professional diagnosis from a medical doctor.
Often the steps required to rule out a brain tumor are relatively simple. One or two consultations with the appropriate doctor and a scan may be all that’s required to rule out a tumor.
If your examination returns normal and you're experiencing symptoms that resemble a tumor, then chances are you have migraine. Your doctor should be able to confirm this with you once tumors have been ruled out.
The good news is that migraines are rarely life threatening. You may be surprised to know that around half the population with migraine haven’t actually been diagnosed. (9)
In addition to being notoriously under diagnosed, migraines are under treated and generally poorly managed according to a report from the World Health Organisation. (10) This means that for a segment of people with migraine it may go on to have significant impact for years and even decades.
Getting quality care, treatment and support is essential to control migraine.
Do you know anyone that has had a brain tumor or have you thought you might have a brain tumor?
1) American Brain Tumor Association ‘Brain Tumor Statistics’. Accessed 28 Jul 2015.
2) Eross, Eric, David Dodick, and Michael Eross. "The sinus, allergy and migraine study (SAMS)." Headache: The Journal of Head and Face Pain 47.2 (2007): 213-224.
3)"General Information About Adult Brain Tumors". NCI. 2014-04-14. Retrieved 8 June 2014.
4) CBTRUS Statistical Report (2012)
5) The Musella Foundation For Brain Tumor Research & Information. Patient Survey n=400.
6) Herholz K, Langen KJ, Schiepers C, Mountz JM (November 2012). "Brain tumors". Semin Nucl Med 42 (6): 356–70. doi:10.1053/j.semnuclmed.2012.06.001. PMC 3925448. PMID 23026359.
7) GBM Guide – MGH Brain Tumor Center". Brain.mgh.harvard.edu. Retrieved 17 February 2012. 8) American Brain Tumor Association. ‘Brain Tumor Statistics’. Accessed 28 Jul 2015.
9) Lipton, Richard B., et al. "Migraine diagnosis and treatment: results from the American Migraine Study II." Headache: The Journal of Head and Face Pain 41.7 (2001): 638-645.
10) World Health Organisation. Lifting the Burden. ‘Atlas of headache disorders and resources in the world 2011.’ WHO Press. 2011.
11) Kleihues P, Ohgaki H, et.al. "Type and frequency of p53 mutations in tumors of the nervous system and its coverings". Molecular Neuro-oncology and Its Impact on the Clinical Management of Brain Tumors. Recent results in cancer research 135. 1994. Springer. pp. 25–31. ISBN 3540573518.
12) Frei P, Poulsen AH, et.al. "Use of mobile phones and risk of brain tumours: update of Danish cohort study." BMJ (Clinical research ed.) 343: d6387. 19 October 2011. doi:10.1136/bmj.d6387.
13) ‘Brain Tumours- Cancer’. Better Health Channel. Victorian State Government Fact Sheet. Accessed 28 Jul 2015.