Approximately 10% of patients with cancer develop brain metastases. Although usually appearing late in the course of the disease, the brain metastasis may be present before the primary cancer has been identified and may present as a single lesion or as multiple lesions. The diagnostic and therapeutic approach depends on the number and location of brain lesions and the stage of the cancer. Patients with brain metastases are rarely cured. However, appropriate treatment can improve both the quality and duration of the patient's life. Treatment must be directed not only at the brain metastasis (definitive care), but also at a multitude of other symptoms that plague patients with cancer and brain metastases (supportive care). Judicious selection of pharmacological agents can effectively treat many serious symptoms in patients with brain metastases, but injudicious selection of pharmacological agents, through side effects, may make the patients' quality of life worse. This article reviews some aspects of both definitive and supportive care with particular attention to the side effects of some commonly used pharmacological agents.