Acute or recent onset of headaches that last a full day or month (primary headaches are often chronic or have trended over the past several years); occurring after age 50; a change in the pattern of chronic headaches Increased intensity or frequency of pain. Pain intensity varies widely, with tumor-induced pain or pain that responds to analgesic medications but eventually progresses to refractory headache. Even if the pain is not too intense it can make it difficult for the patient to sleep (primary headaches usually only interfere with sleep when they are very severe). Unilateral headache. The pain is limited to one side of the tumor. Localized symptoms (unlike migraine, which is reversible and often lasts for a few minutes and less than an hour). Cognitive and behavioral symptoms (easily confused with dementia or psychiatric symptoms). Headache with nausea or vomiting (usually indistinguishable from a migraine). Optic nerve papilloedema suggests intracranial hypertension, but is often rare at diagnosis because imaging is often performed in the early stages of the disease at the time of diagnosis.