title: The clinical characteristics of headache in patients with pituitary tumours.
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.
authors.affiliation: Headache Group, Institute of Neurology, Queen Square, London WC1N 3BG, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Levy
authors.forename: M S
authors.initials: MS
authors.lastname: Matharu
authors.forename: K
authors.initials: K
authors.lastname: Meeran
authors.forename: M
authors.initials: M
authors.lastname: Powell
authors.forename: P J
authors.initials: PJ
authors.lastname: Goadsby
mesh_terms: D000236:Adenoma / Q000150:complications / Q000503:physiopathology*; D000328:Adult; D000634:Aminoquinolines / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001971:Bromocriptine / Q000627:therapeutic use; D000077465:Cabergoline; D004185:Disability Evaluation; D018491:Dopamine Agonists / Q000627:therapeutic use; D004873:Ergolines / Q000627:therapeutic use; D005260:Female; D006261:Headache / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000209:etiology / Q000503:physiopathology; D015282:Octreotide / Q000627:therapeutic use; D010456:Peptides, Cyclic / Q000627:therapeutic use; D010911:Pituitary Neoplasms / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D012720:Severity of Illness Index; D013004:Somatostatin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D000634:Aminoquinolines; D018931:Antineoplastic Agents, Hormonal; D018491:Dopamine Agonists; D004873:Ergolines; D010456:Peptides, Cyclic; C060347:lanreotide; D001971:Bromocriptine; D013004:Somatostatin; C046650:quinagolide; D000077465:Cabergoline; D015282:Octreotide