Headache in pituitary adenomas: frequency, characteristics and outcome after treatment

Headache is common among patients diagnosed with pituitary adenoma (PA). There are still controversies regarding the headache presentation, pathophysiology and outcome after treatment in these patients.

To determine the prevalence of headache among patients with PA, describe their phenotypes and identify precipitating factors. Also, to evaluate prospectively if PA treatment leads to headache improvement.

Treatment-naïve adult patients with PA were included. A questionnaire based on the beta version of the International Classification of Headache Disorders 3rd edition was created to classify the headaches. Patients submitted to surgery or medical treatment were reevaluated at least three to six months after treatment.

Headache during the previous 3 months was present in 62% of the 104 patients. The most prevalent phenotypes were migraine and tension-type headache. Trigeminal autonomic cephalalgias (TACs) were observed only in prolactinoma patients. Both genders presented headache at similar rates (64% in females and 58% in males) but patients with headache were younger (41.5 ± 13.8 vs. 56.8 ± 13.6 years). Tumor characteristics were not determinant of headache. Patients with acromegaly that presented headache had higher GH levels. Headache was more frequent in prolactinomas (83%) than in NFPA (52%). After disease remission or control, resolution of headache was observed in 83%, 50% and 33% of the NFPA, somatotropinomas and prolactinomas, respectively.

Migraine and tension-type are the most common headache phenotypes in PA patients, and TACs were only observed in prolactinomas. Also, headache was more common in prolactinomas than in NFPA. GH levels were higher in patients with acromegaly that presented headache. Surgical and medical treatments completely resolve the headaches in 50% of the patients.