The clinical characteristics of headache in patients with pituitary tumours

Brain. 2005 Aug;128(Pt 8):1921-30. doi: 10.1093/brain/awh525. Epub 2005 May 11.

Abstract

The clinical characteristics of 84 patients with pituitary tumour who had troublesome headache were investigated. The patients presented with chronic (46%) and episodic (30%) migraine, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT; 5%), cluster headache (4%), hemicrania continua (1%) and primary stabbing headache (27%). It was not possible to classify the headache according to International Headache Society diagnostic criteria in six cases (7%). Cavernous sinus invasion was present in the minority of presentations (21%), but was present in two of three patients with cluster headache. SUNCT-like headache was only seen in patients with acromegaly and prolactinoma. Hypophysectomy improved headache in 49% and exacerbated headache in 15% of cases. Somatostatin analogues improved acromegaly-associated headache in 64% of cases, although rebound headache was described in three patients. Dopamine agonists improved headache in 25% and exacerbated headache in 21% of cases. In certain cases, severe exacerbations in headache were observed with dopamine agonists. Headache appears to be a significant problem in pituitary disease and is associated with a range of headache phenotypes. The presenting phenotype is likely to be governed by a combination of factors, including tumour activity, relationship to the cavernous sinus and patient predisposition to headache. A proposed modification of the current classification of pituitary-associated headache is given.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenoma / complications
  • Adenoma / physiopathology*
  • Adult
  • Aminoquinolines / therapeutic use
  • Antineoplastic Agents, Hormonal / therapeutic use
  • Bromocriptine / therapeutic use
  • Cabergoline
  • Disability Evaluation
  • Dopamine Agonists / therapeutic use
  • Ergolines / therapeutic use
  • Female
  • Headache / etiology
  • Headache / physiopathology*
  • Headache / therapy
  • Humans
  • Male
  • Migraine Disorders / etiology
  • Migraine Disorders / physiopathology
  • Octreotide / therapeutic use
  • Peptides, Cyclic / therapeutic use
  • Pituitary Neoplasms / complications
  • Pituitary Neoplasms / physiopathology*
  • Pituitary Neoplasms / therapy
  • Severity of Illness Index
  • Somatostatin / analogs & derivatives*
  • Somatostatin / therapeutic use
  • Time Factors

Substances

  • Aminoquinolines
  • Antineoplastic Agents, Hormonal
  • Dopamine Agonists
  • Ergolines
  • Peptides, Cyclic
  • lanreotide
  • Bromocriptine
  • Somatostatin
  • quinagolide
  • Cabergoline
  • Octreotide