Sirinkarn Sookdee¹

Background: Nasopharyngeal carcinoma is one of the most challenging cancers to diagnose at the initial presentation. Headache is a rare and misleading symptom in diagnosis. This symptom often indicates sphenoid sinus, skull base lesion or intracranial tumor invasion and is therefore a hallmark of advanced disease and a poor prognosis.

Case Report: A 62-year-old male came with a severe left-sided headache for four days. He had vomiting but no weakness or vision problems. After taking analgesics, he still had a severe headache. An endoscopic examination showed a submucosal lesion at the nasopharynx. Computerized tomography scan revealed the enhancing mass over left nasopharynx, across midline to contralateral side, posterior extension to sphenoid sinus and intracranium. A nasopharyngeal biopsy and immunohistochemical staining analysis were performed and shown as nonkeratinizing undifferentiated nasopharyngeal carcinoma. Chemoradiotherapy was performed. The radiation dose was 70 Gy in 33 fractions and chemotherapy was six cycles. At 3-year follow-up, the patient showed decreased size of enhancing mass showing heterogeneous hyperSI on T2Wl. His headache decreased after the treatment.

Conclusion: Headache as a primary clinical presentation without other symptom is extremely rare in patients with nasopharyngeal cancer, leading to delays or misdiagnosis. This is because these symptoms indicate advanced disease and require prompt and appropriate treatment. Therefore, physical examination, radiology and pathology are required to plan further treatment.

Received 15 September 2025 | Revised 11 November 2025 | Accepted 18 November 2025

DOI: 10.35755/jmedassocthai.2025.12.1016-1019-03455