Pain part two: Headaches

Throughout April, our Symptom Sunday is focussing on the leukaemia symptom of pain. Last week, we looked at bone pain, and in today's feature, we're taking a look at headaches and how a severe or sudden onset headache could be a sign of leukaemia.

As we mentioned last week, certain types of pain can be early warning signs of leukaemia. One such pain often reported to precede diagnoses of leukaemia are headaches. In fact, our latest survey shows that around 10% of leukaemia patients experience headaches as a symptom during the build up to their diagnosis.

Almost everyone gets the occasional headache, and nearly always this is caused by something very harmless such as a cold or the flu, stress, lack of regular meals or fluids (dehydration), or eyesight problems. However, there are a few distinct characteristics of a headache that can, on very rare occasions, indicate an underlying serious condition such as leukaemia.

Spotting leukaemia-related headaches

Some people are prone to developing headaches and are somewhat ‘used’ to getting the occasional headache. This is perfectly normal and, generally speaking, any headache that you’ve had multiple times over a period of years, without developing other symptoms, is almost certainly harmless.

It is the “new headaches” or headaches that feel different from any you’ve had before that are worth visiting your GP about.

“I had a banging headache where I could hear my heartbeat in my ears so loud my head felt like it was throbbing, and it would not go away when I lay down.”

When headaches are caused by leukaemia, they are likely to occur frequently and are often severe and long lasting. Many leukaemia patients report waking up in the middle of the night with a headache, along with night sweats and other fever-like symptoms such as general achiness.

However, this does not mean that you should rush to A&E every time you have a fever and a headache. Relatively harmless infections such as the common cold or influenza (flu) are a much more likely cause of fever and headaches. If your symptoms feel unfamiliar or worse to any cold or flu you’ve had before, then you should make an appointment with your doctor.

When should I be concerned?

If you can relate to any of the following descriptions, it is important that you visit your doctor.

  • A sudden, excruciating headache that quickly becomes unbearably painful to the point where you can’t move. Sometimes called a “thunderclap headache”, this is the most concerning type of headache as it can be caused by a life-threatening bleed on the brain. A headache of this nature is an emergency and warrants calling 999.

“It was the worst headache of my life.”

  • A new headache that feels different from any headache you have experienced in the past. Or a noticeable increase in frequency or intensity.

“I decided to see my GP because I was having daily headaches which were getting worse and worse, making work very difficult.”

  • A new headache that comes on after 40 years of age with no prior experience of headaches.
  • A headache that is waking you up at night.
  • A headache accompanied by other symptoms. In the case of leukaemia, this might be visual impairment, vertigo, hearing loss or any of the other more common symptoms of leukaemia (see here).

“I became bed bound with debilitating headaches, bruises, drenching night sweats, fatigue, no appetite, nausea, weight loss, nose bleeds and bone pain.”

Causes of headaches in leukaemia

  1. Anaemia

In leukaemia, cancerous white blood cells can start to crowd out the healthy red blood cells in the bone marrow, causing anaemia. This means that a lower amount of oxygen is able to reach the tissues, including the brain. Low levels of oxygen in the brain can cause the surrounding arteries to swell, leading to headaches.

Other symptoms of leukaemia-related anaemia include weakness and fatigue, breathlessness, pale skin, dizziness and poor concentration.

  1. Leukaemia cells entering the Central Nervous System (CNS)

Leukaemia can also cause your white blood cell count to rise to a dangerously high level. Excess levels of white blood cells can cause the blood to thicken and clog up the small vessels that supply the brain. As well as headaches, this can also lead to symptoms such as nausea, double vision, vertigo, weakness, and sometimes seizures.

  1. Enlarged thymus

A certain subtype of leukaemia called T- cell acute lymphoblastic leukaemia (T-ALL) often affects the thymus gland, a small organ located in the upper chest. In people with T-ALL, the thymus can sometimes become enlarged and can push up against a large vein that pumps blood back from the head to the heart (the Superior Vena Cava). This is known as SVC syndrome, and if it affects blood flow out of the brain it can cause headaches, dizziness and feelings of confusion.

Other symptoms of SVC syndrome include a swollen face, neck, arms and upper chest.

For more information on the signs and symptoms of leukaemia click here.

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