Brain Advance Access originally published online on May 11, 2005
Brain 2005 128(8):1921-1930; doi:10.1093/brain/awh525
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The clinical characteristics of headache in patients with pituitary tumours
1 Headache Group, Institute of Neurology and 2 Department of Neurosurgery, National Hospital for Neurology and Neurosurgery and 3 Department of Endocrinology, Hammersmith/Charing Cross Hospitals Trust, London, UK
Correspondence to: Professor Peter J. Goadsby, Headache Group, Institute of Neurology, Queen Square, London WC1N 3BG, UK E-mail: peterg{at}ion.ucl.ac.uk
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.
Key Words: pituitary tumour; headache; migraine; cluster headache
Abbreviations: IHS = International Headache Society; SUNCT = short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing
Received September 10, 2004. Revised March 30, 2005. Accepted April 2, 2005.
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