Brain metastases are a common complication of cancer and alter patient management more than metastases at any other site of distant progression. Supportive therapies include steroids and antiseizure medications. Definitive treatments include radiation therapy, surgery, and chemotherapy. The optimal choice of treatment and overall prognosis largely depend on patient characteristics and the extent and distribution of disease. Delaying or decreasing neurologic cause of death and disability are important therapeutic goals for this population. While better definitive strategies are investigated, physicians must remember to optimize the use of supportive therapies to ameliorate symptoms and maintain quality of life.