Headache as a Sentinel Signal After Cranial Radiotherapy: A Symptom-Driven Approach to Pathophysiology and Management

Area of Science:

• Neurology
• Oncology
• Radiotherapy

Background:

• Headache is a common symptom in patients receiving cranial radiotherapy.
• It often indicates treatment-related structural changes, such as cerebral edema or radiation-induced brain injury.
• Distinguishing these secondary headaches from primary disorders like migraine is crucial for proper patient management.

Purpose of the Study:

• To review the mechanisms of headache post-cranial radiotherapy.
• To evaluate current treatment strategies, including pharmacological and complementary options.
• To highlight differential diagnosis aspects, particularly differentiating from migraine.

Main Methods:

• A structured narrative review of literature from 2020-2025.
• Searches conducted on PubMed/MEDLINE, Scopus, and Google Scholar.
• Included clinical trials, systematic reviews, and guidelines focusing on cerebral edema, radiation complications, therapies, and migraine.

Main Results:

• Cerebral edema is the primary cause of acute/subacute post-radiotherapy headache; radiation necrosis causes late-onset symptoms.
• Corticosteroids are first-line; bevacizumab shows promise for steroid-refractory edema/necrosis by inhibiting VEGF.
• Evidence for complementary therapies like Boswellia serrata is limited; migraine requires careful differentiation.

Conclusions:

• Headache post-radiotherapy is a critical indicator of underlying structural complications, not just an isolated symptom.
• Accurate diagnosis and individualized treatment are essential for managing these headaches.
• Further research is needed for refined treatments and understanding complementary therapy roles.