Patient-reported headache before and after surgery for pituitary adenomas: a longitudinal single-centre study

To what extent pituitary adenomas cause headache is controversial and the impact of transsphenoidal surgery on headache remains uncertain.

We conducted a prospective, single-centre study of patients undergoing surgery for pituitary adenomas between 2014 and 2024. Headache was assessed using the EORTC QLQ-BN20 module, question four, at baseline, one month, and six months postoperatively. Demographic, clinical, and surgical data were analysed for associations with headache outcomes.

Of 207 eligible patients, 134 completed all assessments (63% male; median age 55 years). Preoperatively, 50% reported no headache, 33% a little, 8% quite a bit, and 9% very much headache. Headache was more common in females, but there was no relation to tumour related factors. At one month, 31% improved, 52% remained unchanged, and 16% worsened. At six months, 34% improved, 56% remained unchanged, and had 10% worsened compared to preoperatively. Among patients with preoperative headache (n = 67), 52% reported improvement at one month and 55% at six months. Among patients with no headache preoperatively, 25% and 12% reported having headache at one and six months, respectively. No demographic, tumour-related, or perioperative variables were significantly associated with headache change.

In this prospective longitudinal study, approximately half of patients with preoperative headache reported improvement following pituitary surgery, while a minority experienced worsening. No clear clinical predictors of headache before surgery or outcome after surgery were identified, suggesting a multifactorial nature of headache in patients with pituitary adenomas.