Abstract
Methods
The possible association of brain tumour with headache was investigated in 100 patients seen for brain surgery. Preoperatively, 43 patients suffered from headache. These patients were thoroughly questioned about the nature of their pain. Investigation included the McGill Pain Questionnaire.
Results
In only 11 of the patients was headache the primary symptom of a brain tumour. Pain intensity was found to be lower in patients with brain tumour then in those with extracranial tumours or headache of other origins. Female subjects, patients under 50 years of age and those with elevated intracranial pressure experienced more intensive pain. Diurnal variation in pain intensity was observed in 60% of patients with headache. There was no evidence, however, of an association with elevated intracranial pressure.
Conclusions
Our investigations yielded new information concerning the epidemology of headache accompanying brain tumours. Headache is not an early cardinal symptom of brain tumours, as was generally believed earlier. With the help of the McGill Pain Questionnaire a fine quantitative and qualitative characterization of headache of different origins could be made. The connection between tumour localization and pain lateralization, as well as the possible mechanisms of intracranial pain projection was extensively analysed. The interpretations of the results are at best hypotheses and they do not help determine why more than half of the patients with brain tumour did not experience headache.
Zusammenfassung
Der Zusammenhang zwischen Hirntumor und Kopfschmerz wurde bei 100 Patienten präoperativ untersucht. Kopfschmerzen führten die Patienten nur in 11 Fällen zum Arzt. Zum Zeitpunkt der Untersuchung klagten 43 Patienten über Kopfschmerzen. Bei ihnen wurde eine detaillierte Schmerzanamnese, inklusive eines McGill Pain Questionnaire, erhoben. Die Intensität der Schmerzen war bei diesem Patientengut niedriger als bei Patienten mit extrakraniellen Tumoren oder Kopfschmerzen anderer Genese. Frauen, Patienten unter 50 Jahre und Patienten mit erhöhtem Hirndruck hatten stärkere Schmerzen. Eine tageszeitabhängige Schmerzintensitätsänderung bestand bei 60% der Kopfschmerzpatienten ohne Zusammenhang mit dem Vorhandensein eines erhöhten intrakraniellen Druckes. Die Zusammenhänge zwischen Tumorlokalisation und Schmerzlateralisation sowie die möglichen Mechanismen der intrakraniellen Schmerzprojektion wurden eingehend analysiert. Eine Interpretation der erhobenen Befunde ist schwer und von hypothetischer Natur. Die Frage, warum über die Hälfte der Patienten mit Hirntumor keine Schmerzen empfand, bleibt weiterhin unbeantwortet.
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Kiss, I., Franz, M. & Kilian, M. Hirntumor und Kopfschmerz. Schmerz 8, 183–189 (1994). https://doi.org/10.1007/BF02530396
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DOI: https://doi.org/10.1007/BF02530396