The headache associated with an intracranial mass is non‑specific and often not localizing.  It is estimated that almost two thirds of patients with brain tumors complain of headache and that half consider headache to be the primary complaint.¹⁴ The headache of intracranial mass lesion is believed to be due to traction on pain sensitive structures within the cranium including the meninges and dural venous sinuses.  The typical headache has a dull, non‑throbbing quality, is of moderate intensity, is worsened by physical activity, especially change in posture, and is intermittent.  The headache is often associated with nausea and vomiting as is typical migraine headache.  Ten percent of adults and two‑thirds of children with brain tumors are awaken from sleep by headache.  Brain tumor headache may be more prominent upon arising.  Supratentorial headaches tend to have some localization to the side of the tumor and posterior fossa tumor headache tends to be bilateral, especially posterior.  Any focal finding on neurologic examination or presence of papilledema in a patient with new onset headache requires neuroimaging and follow‑up. 

Cough headache describes the sudden transient occurrence of diffuse often severe headache precipitated by a valsalva maneuver which occurs upon coughing, sneezing, bending, lifting etc.  It is usually benign, but about 10 percent of such patients have intracranial abnormalities usually in the posterior fossa.  The Arnold‑Chiari malformation, in particular, may present with cough headache, and therefore all patients with this condition must have magnetic resonance scans. 

Increased intracranial pressure alone, without the presence of a mass lesion may be responsible for headache as in the syndrome of benign increased intracranial pressure or pseudotumor cerebri.  These headaches tend to be diffuse, daily, of mild to moderate severity and are usually relieved following reduction of the increased intracranial pressure either by drugs such as acetazolamide or lumbar puncture. Raskin¹⁴ is impressed by the frequency of "migrainous" symptoms in individuals with pseudotumor cerebri and indicates that many persist with headache after papilledema and  increased intracranial pressure have resolved.  It is my experience that headache improvement is a good guide to efficacy of therapy in most patients.  Given the overall frequency of migraine in young women it is not surprising that many with pseudotumor may have migraine as a concomitant condition.