HEADACHE is often the earliest symp tom, and is usually one of the most prominent, constant, and distressing. It is present in from ?5 to 95 per cent. My own experience leads me to believe that it is rarely absent throughout the course of the disease. It is less constant and less severe in certain gliomatous growths. It often intermits, and may be absent for prolonged periods, espe cially while the patient is taking large doses of potassium iodide, although the tumor may not be syphilitic in charac ter. The headache is often agonizing, especially during the periods of its ex acerbation. In some cases the pain is so great, especially in subtentorial tu mors, as to cause death in a few weeks, or, at most, in a few months, from the time that the headache becomes promi nent. It is usually worse at night. In many cases, while the pain is sufficient to interfere with sleep and mental exer tion, it is much less intense than in the severer ones. In not a few the pain amounts to little more than an uncom fortable cephalic fullness or tightness, with an occasional exacerbation. The pain may be laminating, rending, stab bing, dull, heavy, or boring in character. It is usually most severe when the tu mor is rapidly growing, when situated at the base below the tentorium so as to exert pressure on the veins of Galen, or in the cortex; least severe in slowly growing tumors, especially when situated in the centrum ovate. The pain may be
increased by anything that augments the blood-supply to the brain. It may be diffused or limited to one or more regions of the brain. Its location is no positive indication of the seat of the tumor, except in those cases in which the growth is superficial and in volves the membranes, when the pain, and tenderness on percussion, may corre spond to the seat of the morbid process. Tumors in the frontal region less fre quently give rise to occipital pain than a growth in the posterior portion of the brain causes frontal headache. A per sistent occipital or suboccipital pain usu ally points to a subtentorial growth, and, in these cases, pain often radiates down the posterior cervical region. A tumor in one cerebral hemisphere may give rise to pain in the opposite side of the head and nowhere else; but a unilateral occip ital headache usually corresponds to the side of the head on which the growth is situated.