title: Chronic cluster headache and the pituitary gland.
abstract: BACKGROUND
  Cluster headache is classified as a primary headache by definition not caused by an underlying pathology. However, symptomatic cases of otherwise typical cluster headache have been reported.
  
  
  METHODS
  A 47-year-old male suffered from primary chronic cluster headache (CCH, ICHD-3 beta criteria fulfilled) since the age of 35 years. A magnetic resonance imaging (MRI) study of the brain in 2006 came back normal. He tried several prophylactic treatments but was never longer than 1 month without attacks. He was under chronic treatment with verapamil with only a limited effect on the attack frequency. Subcutaneous sumatriptan 6 mg injections were very effective in aborting attacks. By February 2014 the patient developed a continuous interictal pain ipsilateral to the right-sided cluster headache attacks. An indomethacin test (up to 225 mg/day orally) was negative. Because of the change in headache pattern we performed a new brain MRI, which showed a cystic structure in the pituitary gland. The differential diagnosis was between a Rathke cleft cyst and a cystic adenoma. Pituitary function tests showed an elevated serum prolactin level. A dopamine agonist (cabergoline) was started and the headache subsided completely. Potential pathophysiological mechanisms of pituitary tumor-associated headache are discussed.
  
  
  CONCLUSIONS
  Neuroimaging should be considered in all patients with CCH, especially those with an atypical presentation or evolution. Response to acute treatment does not exclude a secondary form of cluster headache. There may be shared pathophysiological mechanisms of primary and secondary cluster headache.
authors.affiliation: Department of Neurology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium. annelien.depue@Ugent.be.
authors.forename: Annelien
authors.initials: A
authors.lastname: De Pue
authors.affiliation: Department of Radiology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Lutin
authors.affiliation: Department of Neurology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.
authors.forename: Koen
authors.initials: K
authors.lastname: Paemeleire
mesh_terms: D000236:Adenoma / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D000077465:Cabergoline; D020863:Central Nervous System Cysts / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D003027:Cluster Headache / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D003937:Diagnosis, Differential; D018491:Dopamine Agonists / Q000627:therapeutic use*; D004873:Ergolines / Q000627:therapeutic use*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010902:Pituitary Gland / Q000473:pathology*; D010911:Pituitary Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D018170:Sumatriptan / Q000627:therapeutic use; D016896:Treatment Outcome; D014700:Verapamil / Q000627:therapeutic use
chemical_list: D018491:Dopamine Agonists; D004873:Ergolines; D018170:Sumatriptan; D014700:Verapamil; D000077465:Cabergoline
keywords: Cluster headache; Pituitary gland; Secondary headache