Headaches in Childhood Cancer
Symptom Management, Palliative Care, or Supportive Care to relieve side-effects is an important part of cancer care and treatment and should always form part of the overall treatment plan.
Virtually everyone gets the occasional headache, and headaches are common in people with cancer, but not all headaches feel the same or have the same cause.
Headaches are generally divided into two main categories: Primary Headaches and Secondary Headaches:
- Primary Headaches include migraines, cluster headaches, and tension headaches. Tension headaches are also known as muscle contraction headaches.
- Secondary Headaches are headaches caused by another medical condition or underlying factor, such as a brain tumour, head injury, infection, or medication.
Both primary and secondary headaches are common in people with cancer. Your child’s doctor will find the best way to treat their headache by determining the type and cause of the headache, based on your child’s symptoms.
Relieving side effects is an important part of total cancer care and treatment, which is why you should discuss any symptoms your child is experiencing, new symptoms and changes in symptoms with their Oncology Team so that they can work out a regimen of palliative or supportive care for them.
As mentioned above, not all headaches are the same, so it is important to determine which type of headache your child has via the symptoms he or she is exhibiting or experiencing.
Headache symptoms are described by several characteristics:
- Duration – how long the headache lasts, ranging from minutes to hours to days. Some headaches start and end very suddenly. Others come and go over several hours or days.
- Frequency – how often the headache occurs, such as occasionally, weekly, or daily.
- Location – where the pain is occurring, such as over the eyes, in the forehead or temples, at the back of neck, or on one side of the head.
- Quality – the type of pain experienced, such as throbbing, stabbing, piercing, pressure, or a dull ache.
- Severity – the degree of pain, ranging from mild to severe and incapacitating (difficulty moving or speaking during the headache). Some headaches start with mild pain that gradually becomes more severe. In other cases, the severity of the pain remains constant.
- Timing – the time of day when the headache occurs. Sometimes, the timing of headaches provides a clue to the headache’s cause. For example, headaches that occur later in the day are often tension headaches.
- Triggers – the factors that bring on a headache, such as exposure to cold, blinking lights, loud noises, or specific foods
In addition to the headache itself, your child may experience additional symptoms related to the headache, including nausea, vomiting, dizziness, blurred vision, sensitivity to light or noise, fever, difficulty moving or speaking, and pain that increases with activity.
As previously mentioned, there are various different types of headaches and they can differ in intensity and duration. There are also various reasons for headaches to occur, and the cause of the headache will determine the treatment of it.
Headaches may be caused by the following factors:
- Cancers: Various types of cancer, including primary cancers of the brain and spinal cord, pituitary gland tumours, nasopharyngeal cancer (upper throat cancer), some forms of lymphoma, and cancer that has spread to the brain.
- Chemotherapy: Some types of chemotherapy, such as fluorouracil and procarbazine can cause headaches
- Immunotherapy: Also called Biologic Therapy, this type of treatment is designed to boost the body’s natural defences to fight the cancer. It uses materials made either by the body or in a laboratory to bolster, target, or restore immune system function.
- Infections: Infections such as sinusitis and meningitis can result in a headache. Sinusitis is an infection of the hollow passages in the bones of the head, called the sinuses. Meningitis is the swelling of the protective membranes covering the brain and spinal cord.
- Medications: Various medications including some antibiotics and anti-emetics (drugs that help prevent or treat vomiting), and heart medications, can cause headaches
- Other: Other conditions or symptoms related to cancer or cancer treatments, such as Anaemia (low red blood count); Hypercalcemia (high level of calcium); Thrombocytopenia (low platelet count); Dehydration (the loss of too much water from the body) caused by severe vomiting or Diarrhoea can also cause headaches
- Radiation: Radiation therapy to the head or the brain
Stress, fatigue, anxiety, and insomnia (difficulty sleeping) may also cause an increase in headaches in Children with Cancer.
It is important to tell your child’s doctor or another member of their healthcare team if they are experiencing frequent or severe headaches, if the headache wakes them at night, if you notice a change in the pattern or frequency of existing headaches, or if the headaches are new and associated with other symptoms.
Basically you need to give the doctor as much information as possible, as it is through and based on these symptoms, together with your child’s medical history and a physical examination, that they will be able to determine the type and cause of a headache, which is the first step in treating or managing it.
Keeping a headache diary to track your child’s symptoms can be helpful. Your child’s doctor may also order tests such as blood tests, a computerised tomography (CT) scan, or Magnetic Resonance Imaging (MRI) of the brain, or other tests based on the pattern and associated symptoms.
Treatment and Management
Headaches caused by an underlying condition such as an infection, are managed by treating the condition that causes the headache where possible. Various medications may be used to treat headaches or reduce the pain, but it is important to get your child’s doctor’s approval before giving them any over-the-counter pain medications.
Medications that are commonly are used to both treat and prevent headaches include:
- Over-the-counter pain relievers, such as Tylenol or Ibuprofen
- Prescription narcotic pain relievers, such as Codeine
- Tricyclic antidepressants
- Triptan medications, such as Sumatriptan
- Steroid medications, especially to treat headaches caused by the spread of cancer to the brain
- Antibiotics, if an infection is causing the headache
Getting enough sleep, eating well, and reducing stress may also help reduce the number and severity of headaches your child has.
Some Complementary Therapies can also help relieve and prevent headaches. Complementary Therapies are basically natural therapies which can be used alongside conventional medical treatment.
Complementary Therapies include Acupuncture, Massage, Visual Imagery, and Relaxation Techniques. Many of these techniques have been found to be beneficial for various side-effects of cancer, and most of them are especially beneficial for Children with Cancer.
Speak to your child’s doctor or other members of your healthcare team about treating your child’s headaches with Complementary Medicine.