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Headaches can be a side effect of different cancer treatments, including chemotherapy (chemo).

Learn more about chemo headaches, other treatments that can cause them, what symptoms to watch out for, and when to seek help.

If you have headaches, but do not have cancer or are not getting cancer treatment, please talk to your doctor about possible causes and how to manage your headaches.

Types of headaches

A headache (pain in the head) can come and go or last for days or weeks at a time.  

Headaches can be acute or chronic.

• Acute headaches last for hours to days then stop.
• Chronic headaches last 15 days or more during the month for more than 3 months.

When the muscles, nerves, and blood vessels in your head and neck are inflamed, it can cause pain. The pain can be mild to severe. Symptoms like nausea or sensitivity to light or noise may happen at the same time.

How often headaches occur, how much pain they cause, and the symptoms will vary from person to person.

There are 3 types of headaches:

• Primary headaches are not always caused by a medical problem. Examples are some types of migraines, tension headaches, and cluster headaches. In people with cancer, primary headaches can feel worse than usual or be more frequent.
• Secondary headaches are caused by a medical condition like vision or hearing problems, head injury, infection (such as sinusitis or meningitis), brain tumor or disorder, or as a side effect of medicine that treats a condition. In people with cancer, secondary headaches may be a side effect of a medication like chemo or because of the cancer itself.
• Neuropathies, facial pain, and headaches that aren’t in other categories may be caused by nerve damage or might be related to certain foods or drinks. 

Who is at risk for headaches?

Primary and secondary headaches are common in people with cancer, either from the cancer itself or because of treatments like chemo, immunotherapy, or radiation therapy. Keep in mind that most medicines, drugs, and treatments can cause side effects, including headaches. Cancer treatments are just one example.

People with cancer who have a history of migraines or other types of headaches before their cancer diagnosis may be more likely to have them during cancer treatment.

Why do chemo and other cancer treatments cause headaches?

Headaches can be caused by direct pressure or irritation to the brain or spinal cord from swelling and inflammation. Sometimes, they are caused by the cancer treatment itself, such as chemo headaches. Examples of cancer treatments that can cause headaches are:

• Some types of chemo (especially if given into the spinal fluid, called intrathecal chemo)
• Radiation to the brain, head, or neck areas
• Surgery in the head and neck area
• Some types of immunotherapy

Cancer or cancer treatments can also result in side effects that might lead to headaches. Some examples of these side effects are:

• Low red blood cell counts (anemia)
• Low platelet counts (thrombocytopenia)
• High calcium levels (hypercalcemia)
• Fluid loss (dehydration) from diarrhea, vomiting, or poor appetite
• Low white blood cell counts (neutropenia) that can increase infection risk

Other medicines

Many medicines used to treat cancer-related symptoms, side effects, or other problems might also cause headaches. These include:

• Pain medicines (like opioids)
• Medicines used to treat infections (antibiotics)
• Medicines for nausea and vomiting (anti-emetics)

Medicines for other conditions, such as heart problems, diabetes, arthritis, autoimmune disorders, and many others, can cause headaches, too.

How does your lifestyle affect headaches?

Other possible causes of headaches in people with cancer can be related to lifestyle. Certain habits, activities, and routines can often trigger headaches. Sometimes, they can result in new or different headaches. Other times, they may worsen chronic headaches. Examples of lifestyle factors that may cause headaches include:

• Stress, tension, and anxiety
• Fatigue
• Lack of adequate sleep
• Changes in diet
• Not drinking enough fluids or dehydration
• Alcohol use
• Caffeine use
• Too much activity or exercise
• Inactivity or lack of regular physical activity

What are other headache symptoms?

The most common symptom people have is pain, but you might also have other symptoms that go along with it. Sometimes, people can predict when a headache is about to start, but some headaches happen without any warning.

Pain

The location of pain, type of pain (quality), and severity will vary person to person.

• Location:  Where you feel the pain. This may be in the back of the neck, forehead/temples, or over the eyes.
• Quality of pain: What it feels like to you. You may describe the pain as throbbing, stabbing, pressure, or dull aching.
• Severity of pain: The level of the pain you have. This may be mild, moderate, or severe. Sometimes, the pain will start as mild and increase to severe. Other times, the pain may be severe when it starts.

Other headache symptoms

Other symptoms may include:

• Nausea or vomiting
• Dizziness
• Blurry, double vision, or vision changes
• Sensitivity to light
• Fever
• Stiff neck
• Pain that gets worse with activity
• Trouble moving or talking

How is the cause of headaches diagnosed?

If you have headaches, you should always tell your cancer care team. They can help you understand the cause and how best to manage them.

If your headache is likely due to treatment, you may not need any tests. But if a headache is not a common side effect of the type of treatment you’re getting, your cancer care team may want to order tests or scans to see if there is a reason for the headaches. They may order:

• Blood tests to check blood counts
• A CT scan or MRI of the brain
• Other tests depending on the headaches and symptoms you are having

How are headaches treated and managed when you have cancer?

Most headaches can be treated and managed at your home. Here are some common tips to prevent and manage headaches.

• Stay hydrated and eat a balanced diet.
• Get regular sleep and physical activity.
• Avoid caffeine or slowly reduce the amount of caffeine you have each day.
• Limit computer or screen time to prevent eye strain.
• Rest in a cool, dark, quiet room.

Sometimes, medicines are used to treat pain from headaches. Your cancer care team may recommend:

• Over-the-counter pain medicines or non-opioid medicines
• Prescription pain medications called opioids
• Certain types of antidepressants (might work for headaches during treatment with chemo or immunotherapy)
• Medications called triptans specifically for headaches
• Antibiotics, if an infection is causing the headache
• Steroids, if the headache is caused by cancer that has spread to the brain

Other times, your cancer care team may recommend non-medical ways to manage pain  with or without other treatments. These can sometimes help relieve pain and prevent headaches. Some examples are:

• Visual imagery
• Relaxation
• Massage
• Acupuncture
• Using warm and cold compresses on your head or forehead

Only you know how much pain you have from the headache. It is important to talk to your cancer care team so they can help you come up with the best plan to manage and prevent headaches during your treatment. It’s a good idea to track your symptoms and note:

• When a headache happens
• What you were doing before it happened
• How bad it is
• How long it lasts
• If anything makes it better or worse 

A daily pain diary might help you keep track of your headache symptoms.

When to seek help?

People with cancer should always tell their cancer care team if they are having headaches.

You should get emergency care or call 911 if:

• Your headache feels like “the worst headache of your life”
• You have these symptoms with your headache:
  • Confusion
  • Feeling as if you will pass out
  • Weakness or inability to use one side of your body
  • Numbness and tingling
  • Difficulty talking or seeing
  • Personality changes

You should call your cancer team if:

• You are having headaches and have never had them before
• Your headache is getting worse
• Your headaches are getting more frequent
• Your headache symptoms include fever or stiff neck
• You fell and hit your head