When to worry about persistent headache with brain metastases

Headache may relate to irritation or pressure around metastatic areas, swelling, bleeding, medicines, dehydration, infection, or a primary headache disorder. Features such as worse pain on waking, pain with vomiting, or pain that changes with position can be useful details for your oncology team. The symptom pattern cannot determine the cause by itself, so assessment is needed.

Note when the headache starts, where it is felt, how severe it becomes, whether it is worse in the morning or with coughing, and whether pain relief works. Record vomiting, vision or speech changes, weakness, numbness, balance problems, drowsiness, and seizures. Contact your oncology team for a new or escalating pattern, and use only pain medicines approved for you.

Call emergency services for a sudden severe headache, seizure, collapse, new weakness or numbness, trouble speaking, marked confusion, severe drowsiness, repeated vomiting, or sudden vision loss. Do not drive yourself if you have neurological symptoms or impaired alertness.

Could this pattern reflect swelling or another treatment-related problem? Do I need urgent examination or imaging? Which pain medicines are suitable with my treatment? What symptoms should prompt emergency help?