Managing symptoms of brain metastases

The most common symptoms of breast cancer in the brain are headaches, nausea, fatigue and seizures. These are caused by pressure or swelling in the brain (‘raised intracranial pressure’).

Medications including steroids are effective at managing symptoms.

We explain the symptoms and how they may be treated, as well as the possible side effects of treatment.

Headaches

Headaches may have many causes including:

• stress and anxiety
• a side effect of treatment
• tense muscles
• tiredness and lack of sleep
• the cancer itself.

They can be throbbing, sharp or a dull pain in the head. You may experience them from time to time or more frequently.

Treating headaches

The steroid dexamethasone is effective in managing headaches. The medication works quickly, so your doctor may prescribe steroids while they investigate other options.

For mild pain, drugs like paracetamol (Panadol) are effective. They work best when you take them regularly rather than waiting for the pain to come back or get worse. Anti-inflammatory medications such as aspirin and ibuprofen are also effective but you should not take them if you are taking dexamethasone.

For moderate pain, pain relief that contains codeine, such as Panadeine and Panadeine Forte, are effective.

For severe pain, you may be given a prescription for morphine-based drugs such as MS Contin and Oxycodone.

You need a prescription for any medication containing codeine or morphine.

Non-medical ways to manage headaches

It’s best to discuss any headache with your doctor so that they can investigate the cause and suggest the right treatment.

Depending on the cause of the headache, the following suggestions may help:

• drink more water
• eat regular, healthy meals
• use a heat pack on your neck to relieve tension
• see a physiotherapist for some exercises or strategies
• relaxation techniques such as deep breathing or meditation
• get plenty of sleep
• do gentle exercise
• be aware of triggers such as caffeine and stress
• take medications as directed by your doctor.

Fatigue

Fatigue (extreme tiredness) is one of the most common side effects of metastatic breast cancer. It may be the result of several factors including:

• anaemia (low red blood cell count)
• side effects of treatment
• poor nutrition.

Steroid drugs such as dexamethasone can be helpful as they boost energy and appetite.

Read about Fatigue and ways to reduce it during treatment. For tips on improving your appetite, go to Poor appetite related to metastatic breast cancer.

Seizures

A seizure or fit is a short period of uncontrolled electrical activity in the brain.

Common signs of a seizure are:

• muscle twitching or stiffness
• loss of consciousness

They can happen without warning and can be very frightening to experience or to watch.

Your doctor may recommend anti-epileptic drugs if you have had a seizure or to prevent seizures. This medication may cause drowsiness.

About steroids

Steroids reduce the swelling in the brain and can relieve symptoms such as headache and nausea.

The most common steroid prescribed for metastatic breast cancer is dexamethasone. This is a tablet.

Usually you start with a higher dose. This dose is reduced once other treatments such as radiotherapy have taken effect.

It is best to take the medication:

• with food to prevent indigestion
• early in the day to help you sleep better at night.

If you are likely to be on dexamethasone for longer than a week, your doctor may also give you:

• medicine to help prevent stomach ulcers and indigestion
• medication to help you sleep.

Side effects of steroids

Side effects of steroids can include:

• increased appetite and weight gain
• indigestion if you take them on an empty stomach
• disturbed sleep if you take them late in the day
• oral thrush (‘candidiasis’)
• mood swings
• muscle weakness
• puffiness in the face
• skin changes.

Side effects such as puffiness of the face or weight gain are temporary. They should improve once you stop taking steroids.

Steroids and diabetes

Steroids can increase blood sugar levels and, in some cases, bring on diabetes.

If you are diabetic, it’s important to carefully monitor your blood sugar levels when you are taking dexamethasone.