Resolution of headache after reduction of prolactin levels in hyperprolactinemic patients

Abstract

Prolactin (PRL) secreting adenomas are associated with high incidence of headache. The role of hyperprolactinemia in the headache context is not clear, nor is the effect of its treatment on headache. Methods: The present longitudinal study evaluated hyperprolactinemic patients (69), in terms of presence and characteristics of headache before and after hyperprolactinemia treatment. Results: Headache was reported by 45 (65.2%) patients, independent of the etiology of hyperprolactinemia. The migraine phenotype was the most prevalent (66.6%). Medications used in the treatment of headache not changed during the study. The first line of treatment of hyperprolactinemia was dopaminergic agonists. In the last reevaluation, PRL level under treatment was within the reference range in 54.7% of the cases, and it was observed complete or partial resolution of the headache in 75% of the cases. The median PRL at this time in patients with complete headache resolution was 17 ng/mL, in those who reported partial recovery was 21 ng/mL, and in those in whom the headache did not change was 66 ng/mL, with a significant difference between the group with complete headache resolution vs. the group with unchanged headache (p=0.022). In the cases with complete headache resolution, the median fall on PRL levels was 89% and in those cases with partial headache resolution 86%, both significantly different (p<0.001) from the fall in the cases with an unchanged headache. Conclusion: Data allow us to conclude that, in this series, in the majority of cases the reduction in the level of PRL was followe3d by cessation or relief of the pain.

Prolactin in headache and migraine: A systematic review of clinical studies

“…Therefore, D2 receptor antagonists are recommended on the treatment of acute migraine attacks (67,68). D2 receptor agonists, however, relieve migraine pain in the presence of prolactinoma (56,69). Further studies with control groups investigating the correlation of pain relief and PRL level are needed to draw a conclusion on PRL involvement in treatment response.…”

“…Enhances PRL secretion in rodents [78]. patients with prolactinomas compared to nonfunctioning pituitary adenomas (54) and lowering PRL levels with D2 receptor agonist relieved headache in hyperprolactinemic patients (56).…”

“…The authors concluded that increased intrasellar pressure might be the major mechanism contributing to the development of hyperprolactinemia. Oliveira and colleagues (56) included in a longitudinal study 69 patients with PRL-secreting adenoma. Of these, 45 (65%) patients reported headache.…”

A Link Between Migraine and Prolactin: the Way Forward

“…Usually, prolactinoma-associated headaches are localized on the same side as the tumor and respond well to dopamine agonists [ 9 , 53 ]. A longitudinal study [ 10 ] evaluated patients with hyperprolactinemia for presenting the characteristic of headache before and after treatment by D 2 agonists. In this study, prolactin levels were decreased after treatment and the pain subsided.…”

“…Historically, two lines of evidence have been presented that link prolactin and migraine. First, in hyperprolactinemia, headaches with migraine characteristics have been described and normalization of the prolactin level has alleviated headaches [ 9 , 10 ]. Moreover, in migraine patients, higher levels of prolactin have been identified that were also responsive to drugs lowering the prolactin level [ 11 , 12 ].…”