title: Headaches associated with Rathke's cleft cyst.
abstract: OBJECTIVE
  Headaches are common presentations in patients with Rathke's cleft cyst (RCC). This study was conducted to elucidate the characteristics and underlying mechanisms of the headache.
  
  
  METHODS
  We retrospectively studied 46 patients with RCC, 33 of whom underwent surgical intervention.
  
  
  RESULTS
  Headache, particularly frontal headache, was the most common symptom, occurring in 27 patients (58.7%). Eleven patients with sudden episodic headache mimicking that of pituitary apoplexy. Although the presence of headache did not correlate with cyst size, it was significantly more common in RCCs with: high- and iso intensity content on T1-weighted MR image (P= .0363), mucous content within the cyst (P= .0023), and intense chronic inflammation at the cyst wall (P= .0276). Among 6 patients with histologically recognized intense inflammation, every patient had frontal headache (P= .0407), 5 patients had episodic headache (P= .0002), and 4 patients had associated hypopituitarism (P= .0073), none of which improved after surgical intervention. Headaches improved after surgery in 17 of 21 patients (81.0%).
  
  
  CONCLUSIONS
  Headache, particularly frontal episodic headache, is a common and characteristic manifestation in patients with RCC and may indicate intermittent inflammatory reactions caused by mucous content. Patients with episodic headache should undergo surgical treatment to prevent exacerbation of the inflammation that can result in irreversible endocrine dysfunction.
authors.affiliation: Department of Neurosurgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nishioka
authors.forename: Jo
authors.initials: J
authors.lastname: Haraoka
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Izawa
authors.forename: Yukio
authors.initials: Y
authors.lastname: Ikeda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020863:Central Nervous System Cysts / Q000150:complications* / Q000473:pathology / Q000601:surgery; D005260:Female; D006261:Headache / Q000209:etiology*; D006801:Humans; D007249:Inflammation / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies