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. Conclusion. 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.
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