Headaches are common, albeit unpleasant, experiences. They are not generally a symptom of breast cancer unless the cancer is advanced and spreads to the brain. Individuals diagnosed with breast cancer may also experience headaches related to treatment.
This article explores the possible causes and management options for headaches associated with advanced breast cancer or breast cancer treatments.
What Are Headaches?
A headache is a pain or discomfort in the head or face. Headaches vary in severity, location, and quality. They are generally classified as primary or secondary.
Most primary headaches fall into these three categories:1
- Tension-type headaches feel like a tightening or a sensation of pressure around the head. The pain is mild to moderate in intensity and can be associated with shoulder and upper back stiffness.
- Migraine headaches feel like throbbing pain on one or both sides of the head. The pain is moderate to severe in intensity and may be associated with nausea, vomiting, and sensitivity to light, sound, and smell.
- Cluster headaches feel like an excruciatingly sharp or stabbing pain on one side of the head. These headaches are associated with restlessness, red or watery eyes, stuffy nose, or forehead sweating.
Secondary headaches vary based on their underlying origin. They may arise from a brain infection, tumor, injury, or other problem with the nerves or blood vessels within your head or neck.
Are Headaches a Symptom of Breast Cancer?
Headache is not a symptom of breast cancer, but it might occur if cancer spreads to the brain. Treatments used in breast cancer may also cause headaches as a side effect. In both instances, such a headache is considered a secondary headache.
Advanced Breast Cancer
Breast cancer develops when abnormal breast cells grow uncontrollably within the breast lobules (glands that make milk), ducts (tubes that carry milk to the nipple), or fatty tissue.
Advanced breast cancer, also called metastatic, or stage 4, breast cancer, occurs when breast cancer cells travel (metastasize) beyond the breast to other organs within the body. The brain is one of the most common sites of breast cancer metastasis, along with the bones, liver, and lungs.
In patients with brain metastasis, headache is often the first symptom.2 A headache from brain metastasis is often described as being worse in the morning or aggravated by the Valsalva maneuver (like coughing or bearing down during a bowel movement).
However, recent research suggests that this "classic" headache is uncommon.3 Instead, headaches from brain metastasis are variable. They can resemble tension-type headaches, migraine headaches, or a combination of these.
In rare instances, hydrocephalus (a buildup of fluid in the brain) may occur if the breast cancer has spread to the meninges (the membranes surrounding the brain).
Breast Cancer Treatments
Various therapies used to treat breast cancer may cause headaches as a side effect.
Examples of such treatments include:6
- Chemotherapy: These drugs kill fast-growing cancer cells. Some, like Ixempra (ixabepilone), can cause headaches as a side effect.
- Hormone therapy: These drugs block the body's ability to make estrogen or interfere with estrogen's effect on breast cancer cells. The injectable hormone therapy Faslodex (fulvestrant) may cause headaches.7
- Immunotherapy: These drugs use a person's immune system to recognize and kill cancer cells. Headache is a side effect of Keytruda (pembrolizumab), an immunotherapy drug used to treat triple-negative breast cancer.
Treatment and Management of Headaches
After determining the cause of your headache, your healthcare provider can help you formulate a safe and effective treatment plan.
Advanced Breast Cancer
If your headache is related to breast cancer metastasizing to the brain, treatment options may include surgery, radiation, or medication. Steroids (anti-inflammatory drugs) can also help reduce brain swelling from cancer buildup.
With a headache from hydrocephalus, a shunt (a tube to drain fluid) may be placed to relieve the pressure.
Breast Cancer Treatments
Your healthcare provider may switch your medication if you develop debilitating headaches related to breast cancer treatment. Alternatively, if your headache resembles a primary headache disorder, your healthcare provider will treat it as such.
For example, if the headache feels like a tension-type headache, simple home remedies, such as applying heat or ice, massage, eating a healthy snack, or taking a nap, may relieve it.
If these remedies don't help, your healthcare provider may suggest an over-the-counter (OTC) drug, such as Tylenol (acetaminophen) or a nonsteroidal anti-inflammatory drugs (NSAIDs) like Aleve (naproxen sodium), Motrin Advil (ibuprofen), or Bayer, Bufferin, or Ecotrin (aspirin).
Likewise, if your headache resembles a migraine, your provider may recommend an OTC NSAID or a prescription triptan, like Imitrex (sumatriptan). Napping in a dark, quiet room or placing a cold pack on the area of head pain can also be helpful.
When to See Your Healthcare Provider
Most headaches are not dangerous, although there are situations in which your headache warrants prompt or emergent medical care.
See your healthcare provider if:
- Your headache pattern is changing or affecting your daily routine.
- You have a new headache and are over age 65, are pregnant or just gave birth, or have a history of cancer or a weakened immune system.
- Your headache is triggered by sneezing, coughing, or exercising.
- You are having headaches and frequently taking pain-relieving medication.
Go to your nearest emergency room if:
- Your headache is severe, starts abruptly, and/or is the "worst headache of your life."
- Your headache is severe and associated with a painful red eye, high fever, stiff neck, or stroke symptoms (e.g., vision changes, weakness, or numbness).
- Your headache occurs after a head injury.
Nearly everyone experiences a headache at some point. They are usually primary headaches and not a symptom of breast cancer unless cancer cells have traveled to the brain. Surgery, radiation, medication, shunt placement, or a combination of these are used to treat breast cancer that has spread to the brain.
Drugs used to treat breast cancer may also cause a headache as a side effect. These headaches are typically treated with OTC or prescription headache painkillers. Your healthcare provider may consider altering your breast cancer medication if you have disabling headaches.