How should I manage symptoms such as headache or seizures in a patient diagnosed with metastatic brain cancer?

Management of headache and seizures in metastatic brain cancer:

• For seizures associated with brain metastases, consider antiepileptic treatment following the NICE guideline on epilepsies in children, young people and adults, as brain tumour-associated epilepsy can significantly impact wellbeing.
• Headaches related to brain metastases may be managed symptomatically; corticosteroids can be used to reduce peritumoral oedema, which often contributes to headache and neurological symptoms.
• Referral to specialist neuro-oncology and palliative care teams is important to optimise symptom control and provide psychological support.
• For patients with a single or limited number of brain metastases causing symptoms such as headache or seizures, consider maximal local therapy (surgery, stereotactic radiosurgery, or radiotherapy) to reduce tumour burden and associated symptoms, taking into account patient factors and preferences.
• Regular clinical review and imaging should be arranged for patients with brain metastases who develop new or changing neurological symptoms, including headache or seizures, to assess disease status and adjust management accordingly.

These approaches aim to control symptoms, improve quality of life, and address underlying causes of neurological symptoms in metastatic brain cancer ¹,².