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Brain Advance Access published online on May 11, 2005
Brain, doi:10.1093/brain/awh525
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© The Author (2005). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Received September 10, 2004
Revised March 30, 2005
Accepted April 2, 2005

Article

The clinical characteristics of headache in patients with pituitary tumours

M. J. Levy 1, M. S. Matharu 2, K. Meeran 3, M. Powell 4, and P. J. Goadsby 2*

1 Headache Group, Institute of Neurology, London, UK; Department of Endocrinology, Hammersmith/Charing Cross Hospitals Trust, London, UK
2 Headache Group, Institute of Neurology, London, UK
3 Department of Endocrinology, Hammersmith/Charing Cross Hospitals Trust, London, UK
4 Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK

* To whom correspondence should be addressed.
P. J. Goadsby, E-mail: peterg{at}ion.ucl.ac.uk


  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.

Keywords: pituitary tumour; headache; migraine; cluster headache.
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