Brain tumor is usually not cause of headache

The woman was worried about her son, a soldier, who suffers debilitating headaches with no clear cause. He's had MRIs, but his mom wondered if he could have a brain tumor.

"Unlikely," Dr. Ali Choucair, LDS Hospital neuro-oncologist, told her during Saturday's Deseret Morning News/Intermountain Healthcare Hotline. The chance that any headache is caused by a brain tumor is less than 1 percent. And the chance a brain tumor would be missed on a complete MRI is "almost zero," Choucair said.

Calls to the hotline included people who'd already been diagnosed with a brain tumor and people who might be among the "worried well."

Dr. William T. Sause, director of cancer services for Intermountain Healthcare and chief of oncology at the Jon and Karen Huntsman Cancer Center that just opened at Intermountain Medical Center, talked to a couple of callers who worried their brain tumors might recur. Cancer survivors never quite forget that it happened to them once. And "people are anxious. It's part of our social conditioning."

Headaches are seldom linked to brain tumors, the two doctors agreed. It's figuring out which headaches or other symptoms are different from normal and then whether screening needs to be done.

"Medicine is really recognizing patterns," Choucair said. He'd be more concerned about someone who was 50 and having the first big headache of his life or someone who also has a symptom such as unexpected memory loss.

Someone who is worried should check with his or her primary care physician, who has a more complete picture of their medical history and therefore what's significant.

The doctors said most brain cancers don't spread throughout the body, but it's quite common for other cancers, such as lung cancer, to spread to the brain. Any solid-tumor cancer can spread there, Sause said.

The two doctors are part of a multidisciplinary treatment team that includes neurosurgeons, radiation oncologists, a neurological oncologist (Choucair's the only one in Utah), medical oncologists, neurological radiologists, nurses, social workers and others.

They try to remove tumors surgically if possible, sometimes with a Gamma Knife with no incision, just targeted radiation. There's reluctance to use radiation or chemo in younger patients if it can be avoided, because years later they may experience delayed effects.

Chemotherapy's value is not proven with low-grade tumors, said Choucair, who added that it is low-grade tumors that are most likely to be completely removed surgically. With high-grade tumors, a portion benefit from chemo.

Radiation is still the foundation of treatment, and is frequently used after surgery, as well. It's now much safer because doctors can target the cancerous cells precisely, while delivering a much lower dose of radiation to other cells.

The hotline tackles a different topic the second Saturday of each month.

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E-mail: lois@desnews.com