[Headache of unknown origin: brain tumor? Indications for computer tomography].

Headache is the most frequent initial as well as the principle symptom of brain tumours. In 25 patients with brain tumours, in whom the initial symptom was headache, a further symptom of cerebral origin did not appear until after an interval of 40 months on average (median 11.5 months, 95% confidence limits of the median 4 and 60 months). Whereas tumours associated with short case-histories of headache are mostly glioblastomas, previously unrecognised tumours associated with long-standing headache are predominantly slow-growing, in the main easily operable, brain tumours. Pure headache-tumours occur predominantly in "silent" regions: in the subdominant (right) hemisphere and also in the frontal lobes as well as mid-basal in the sella area. In comparison with electroencephalography, X-ray of the skull, scintigraphy and sonography, computerised tomography is the superior non-invasive diagnostic procedure. A tumour-excluding headache does not exist. A typical migraine attack, when appearing for the first time in middle-age, can be the first indication of a brain tumour. Any reservations on the use of computerised tomography in regard to headache, when this has not been present since childhood as intermittent migraine, are, even from the point of view of cost, no longer tenable.