Can Frontal Meningiomas Cause Dizziness and Headaches?
Yes, frontal meningiomas commonly cause headaches, but dizziness is not a typical presenting symptom of frontal lobe meningiomas specifically.
Headache as a Primary Symptom
Headache is the most common presenting symptom of meningiomas overall, occurring in the majority of patients and characteristically presenting as diffuse and progressive over days to weeks 1. In a prospective study of 85 brain tumor patients, headache prevalence reached 60%, though it was the sole presenting symptom in only 2% of cases 2.
Frontal lobe meningiomas specifically present with headache as the primary symptom before other neurological deficits become apparent 1. The pain is generally:
- Dull in character 2
- Moderate intensity 2
- Not specifically localized 2
- Nearly 40% meet criteria for tension-type headache 2
Important Nuance About Headache Location
A critical finding from research is that only infratentorial tumors were associated with specific headache location, predominantly occipital but rarely frontal pain 2. This means frontal meningiomas do not necessarily cause frontal headaches—the pain pattern is typically diffuse rather than anatomically corresponding to tumor location 2.
Dizziness: Not a Characteristic Symptom
Dizziness is not listed among the typical presenting symptoms of frontal meningiomas in guideline-level evidence. The characteristic symptoms of meningiomas based on location include 1:
- Headache (most common)
- Visual disturbances
- Seizures (focal or generalized) 3
- Mental changes (for frontal locations)
- Neurological deficits from compression of adjacent neural tissue 3
When Dizziness Does Occur with Meningiomas
Dizziness can occur with meningiomas in specific contexts:
- Posterior fossa meningiomas may present with gait difficulties 4, which patients might describe as "dizziness"
- Foramen magnum meningiomas can cause ataxia and balance problems 5
- Increased intracranial pressure from any location might produce nonspecific symptoms including lightheadedness 6
Clinical Algorithm for Evaluation
Red Flags Requiring Urgent Imaging
When a patient presents with headache and suspected meningioma, obtain MRI with contrast urgently if 1:
- Progressive headache over days to weeks
- Visual disturbances (blurred vision, diplopia)
- Seizures
- Mental status changes
- Any abnormal neurological findings
Specific Features to Assess
- Headache awakening patient from sleep suggests increased intracranial pressure 7
- Worsening with Valsalva maneuver indicates elevated ICP 7
- Rapidly increasing frequency increases likelihood of significant pathology 7
Diagnostic Workup
MRI with contrast is the gold standard for evaluating suspected meningiomas 1. Look for:
Common Pitfalls to Avoid
Do not assume normal neurological examination excludes significant pathology in the setting of progressive symptoms 7. Meningiomas are often discovered incidentally because symptoms may be absent even with enormous tumor size 9.
Do not expect headache location to correspond to tumor location for supratentorial tumors—only infratentorial meningiomas show this correlation 2.
If true vertigo or dizziness is prominent, consider alternative diagnoses or look for posterior fossa involvement rather than assuming a frontal meningioma is the cause 5.