Do I Have a Headache or a Brain Tumor?

Welcome to Am I Dying, a column that hopes to save you from your late-night WebMD spiraling. You can email us your hypochondriac questions at amidying@nymag.com.

Every once in a while I’ll get a headache in my right or left temple (it happens to both, but only one side at a time) that lasts for two or three days. And almost every time, I become convinced I have a brain tumor. Why else would I only feel it on ONE side like that, if not for a tumor pressing against that spot on my skull? I drink more water, I take Advil, and I sleep, and sometimes these things help. I can’t afford to get a brain scan every time this happens to me, as much as I might want to, sooo … what would it look like if I DID have a brain tumor?

I hear you. As someone so nearsighted I would for sure just die immediately in the event of a zombie apocalypse, and as someone who writes for the internet full-time (and watches TV on my laptop a good portion of the rest of the time), I get … a lot of headaches. Especially in the summer, which is known to be harder on migraine sufferers and cluster headache sufferers alike. (More on what each of those means in a moment.) Most of the time, I’m able to take two Advils and move on with my life, but sometimes (especially if there’s been a recent tragic news story about a young person dying of a brain tumor), my anxiety takes over, and I become convinced that something much more serious is happening.

At some point in my history of probably-unnecessary urgent care visits, a nurse once told me that the real warning sign of a brain tumor is a headache coupled with projectile vomiting (!). Knowing that comforts me (sort of), but I wanted to get a second opinion, so I reached out to Dr. Lawrence Newman, the director of the headache division in the department of neurology at NYU Langone.

First, some reassurance: According to Newman, a one-sided headache like the one you’re describing is almost always a migraine. (Of course, migraines can be awful and debilitating in their own right, but I think it’s safe to assume that they are generally preferable to brain tumors.) The word migraine, Newman tells me, actually means “half of the head” (the more you know!), so one-sided pain is, accordingly, its most notable trademark. Migraines are very common, affecting 36–44 million Americans, Newman tells me — and more of them women than men. They’re characterized by pain felt in one temple and behind the eye on the same side, though there are many other ways migraines manifest, too.

Crucially, migraines are “a lot more than a headache,” says Newman. “If you have a one-sided headache and you’re nauseated, you’re vomiting, and you have light and sound and smell sensitivity, the odds are that you’re dealing with a migraine.” Migraines also run in families, and typically last between 4 to 72 hours. So if you have a family history of migraines, and you’ve had one-sided headaches before, it’s a good chance that’s what you’re experiencing — but only a doctor can only tell you for sure.

Other forms of benign headaches include tension headaches, which are characterized by a vise-like pressure felt around the skull, and can last for days, but typically do not present with any other symptoms, says Newman. Cluster headaches, like migraines, are one-sided, but they’re generally much more painful: “People with cluster headaches say it feels like somebody is sticking a hot poker through their eyeball,” explains Newman, weirdly calmly. Cluster headaches, as the name suggests, come in waves — sufferers can have as many as eight a day. Unlike migraines and tension headaches, though, they’re usually over relatively quickly, in 20 to 45 minutes (small mercies), says Newman. They’re also so intense that they’re usually accompanied by one or more of the following: “On the side of the pain, the eyelid gets droopy, so it hangs lower; the eye gets bright red; the pupil gets smaller; or the eye starts to tear uncontrollably,” says Newman.

Okay, so now, let’s talk about brain tumors. Newman agrees with my urgent-care nurse that vomiting is the most reliable giveaway. “The classic teaching in medical school of the brain tumor is that it’s a headache with vomiting, usually vomiting without nausea,” he says. “So it’s projectile vomiting. You don’t get nauseated, you just start to vomit.” Headaches associated with brain tumors also tend to feel worse when you’re lying down than sitting up — in fact, it’s typical for them to wake you in the middle of the night, says Newman. Critically, brain-tumor-associated headaches do not end, and get worse and worse with time, and will start to present with other symptoms, like numbness or weakness on one side of the body and/or speech difficulties and vision difficulties. They also arrive out of nowhere, as what Newman calls “thunderclap” headaches: sudden and severe.

But if your headache is mild to moderate, and fits the description of one of three common forms of benign headaches, Newman recommends the usual: ibuprofen or Excedrin, lots of water, and either a hot shower or an ice pack, depending on your preference. In the vast majority of cases, it’ll pass.

Do I Have a Headache or a Brain Tumor?