title: Headache as the sole symptom of nasopharyngeal carcinoma and its clinical implications.
abstract: BACKGROUND
  This study aimed to investigate the clinical features of NPC presenting with headache as the primary or sole symptom.
  
  
  METHODS
  The authors retrospectively identified 14 cases of NPC with headache as the initial presentation between 2003 and 2008. Headache characteristics, tumor staging, and treatment outcomes were assessed.
  
  
  RESULTS
  Most patients had either T4 (n = 12) or T3 (n = 1) tumor. The average duration of headaches prior to NPC diagnosis was 7.9 months. The location of the headaches was most commonly described as temporal or parietal with various pain patterns. Six patients (43%) experienced unilateral headache during attacks while the remaining patients reported bilateral or diffuse pain. Of the 14 patients, 10 (71%) experienced significant improvement in head pain during or after the treatment; most of them reported relief shortly after chemoradiation was initiated. The 5-year overall survival of these patients was similar to that of other NPC patients.
  
  
  CONCLUSIONS
  Headache can be the only symptom of NPC. A timely diagnosis, albeit challenging to physicians, provides good outcomes in terms of both pain relief and tumor control.
authors.affiliation: Department of Otolaryngology, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan.
authors.forename: Yi-Lun
authors.initials: YL
authors.lastname: Lee
authors.forename: Ching-Yin
authors.initials: CY
authors.lastname: Ho
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D012189:Retrospective Studies; D063189:Symptom Assessment / Q000379:methods*