An unusual case of headache.

We report an unusual case of carcinomatous meningitis presenting as a headache in a previously well woman. It occurs in only 3-5% of solid tumours and is an unusual form of presentation for underlying primary malignancy. This 44-year-old woman initially presented with subacute headache of 3 weeks duration and was treated as migraine, and later thought to have viral meningitis. The diagnosis was made from cytology examination on repeated lumbar puncture of cerebrospinal fluid (CSF). Within a month of onset of symptoms, the patient developed gradually worsening headache, right 6th cranial nerve palsy with associated diplopia as well as refractory generalised tonic-clonic seizures. Treatment included CSF drainage through insertion of Ommaya reservoir, and palliative systemic chemotherapy. Further palliative chemotherapy was withheld upon patient's and family's request. The patient died shortly after initial treatment; 7 weeks after her initial presentation to her general practitioner with headache.