Refractory Headache in a Patient with Breast Cancer and Carcinomatous Meningitis Unresponsive to Analgesics

A 44-year-old female presented with locally advanced breast cancer that had been treated with neoadjuvant chemotherapy followed by modified radical mastectomy and thereafter three cycles of paclitaxel. She presented with severe refractory headache that was unresponsive to oral analgesics including morphine. Both CT and MRI scans with contrast were normal, however her cerebrospinal fluid was positive for malignant cells. The patient's headache responded to whole brain radiotherapy.