Headache in patients with pituitary adenoma: clinical and paraclinical findings.
OBJECTIVE
The aim of this article is to generate hypotheses for the mechanism of pituitary adenoma headache.


METHODS
Fifty-eight patients with pituitary adenoma were prospectively analysed for prevalence and manifestation of tumour headache. Intrapersonal and neoplasm-associated risk factors were assessed.


RESULTS
Twenty-four patients (41%) had tumour-attributed headache, seven had migraine-like, 11 tension-type headache-like headache, and three both. Cluster headache-like headache was found once, and two headaches remained unclassified. Tumour-attributed headache was associated with a positive history of headache (p = 0.03; OR 3.4), nicotine abuse (p < 0.01; OR 4.7), intake of acute headache medication (p = 0.04; OR 3.3), and a higher tumour proliferation indicated by a Ki67-labelling index (LI) >3% (p = 0.02; OR 11.0). For patients with migraine-like tumour-attributed headache, risk factors were younger age (p = 0.02), nicotine abuse (p < 0.01; OR 10.9), acute headache treatment (p < 0.01; OR 9.0), and Ki67-LI >3% (p = 0.03; OR 14.1). For tension-type headache-like headache, the main risk factor was a positive history of tension-type headache (p = 0.045; OR 5.6).


CONCLUSIONS
Headache predisposition and local tumour effects might be important for the pathophysiology of pituitary adenoma headache and tumour headache in general.
Department of Neurology, University of Munich Hospital - Grosshadern, Germany. christoph.schankin@med.uni-muenchen.de
Christoph J
CJ
Schankin
Anna K
AK
Reifferscheid
Markus
M
Krumbholz
Jennifer
J
Linn
Walter
W
Rachinger
Sigrid
S
Langer
Petra
P
Sostak
Thomas
T
Arzberger
Hans
H
Kretzschmar
Andreas
A
Straube
D000236:Adenoma / Q000453:epidemiology* / Q000503:physiopathology; D000328:Adult; D017677:Age Distribution; D000368:Aged; D005260:Female; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000453:epidemiology* / Q000503:physiopathology; D009538:Nicotine / Q000009:adverse effects; D018722:Nicotinic Agonists / Q000009:adverse effects; D010911:Pituitary Neoplasms / Q000453:epidemiology* / Q000503:physiopathology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D018781:Tension-Type Headache / Q000453:epidemiology* / Q000503:physiopathology; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000503:physiopathology
D019394:Ki-67 Antigen; D018722:Nicotinic Agonists; D009538:Nicotine