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By Charles J. Vecht MD, PhD (auth.), David Schiff MD, Patrick Y. Wen MD (eds.)

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4% The high incidence of headache from extracerebral tumors located near the skull base, which is the center of the aforementioned pain-sensitive structures, appears to support the traction concept. Traction or stretching can occur by one of two mechanisms: direct or indirect. Direct involvement occurs from local traction or invasion of pain-sensitive structures by the tumor mass itself. Indirect mechanisms occur either through: (1) distant traction or (2) stretching of one or more of these structures by tumor effects such as: (a) hydrocephalus, which results in compression of normal brain parenchyma and other structures, or (b) associated edema from the brain tumor resulting in compression of structures that may be far removed from the tumor mass itself.

Vick NA. Letter to the editor. J NeurooncoI1988;6:199. 10. Dropcho EJ, Soong SJ. Steroid-induced weakness in patients with primary brain tumors. Neurology 1991;41:1235-1239. 11. Ruff, RL. Endocrine myopathies. In: Myology: Basic and Clinical. Engle AG, Banker BQ, eds. McGraw-Hill, New York, 1986, pp. 1871-1879. 12. Koski CL, Ritenberick DH, Max SR. Oxidative metabolism of skeletal muscle in steroid atrophy. Arch NeuroI1974;31:407-41O. 22 PALEO LOGOS AND VICK 13. Kelly FJ, McGrath JA, Goldspink DF, Cullen MJ.

The purpose of this chapter is to elucidate the cause of headache in brain tumors, to describe the characteristics of headaches in patients with brain tumors (primary or metastatic), to identify the factors that cause these headaches and to provide a diagnostic and management approach. gical and clinical features of headaches in patients WIth bram tumors will be presented to aid the clinician in differentiating benign headaches from those requiring further investigation. In general practice, headaches are one of the most common presenting symptoms, resulting in 10-15% of office visits with approx 11 million people in the United States having migraine headaches (1).

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