Clinical Presentation and Management of Headache in Pituitary Tumors

Suri, Himanshu; Dougherty, Carrie

doi:10.1007/s11916-018-0710-8

Cited by 19 publications

(16 citation statements)

References 56 publications

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“…Other interesting findings of the study by Lima Carvalho et al are that it is not as yet possible to identify hypothyroid patients who are susceptible to developing HAH and that the clinical characteristics of HAH did not differ between patients with subclinical and overt hypothyroidism. Additionally, in the case of non‐responders after 3 months of hormone replacement, Lima Carvalho et al suggested neuroimaging investigation, to differentiate from other conditions related to low levels of thyroid hormones, and a combination of preventive drugs with levothyroxine when no secondary cause is identified.…”

Section: Discussionmentioning

confidence: 99%

Relationship of Migraine and Tension‐Type Headache With Hypothyroidism: A Literature Review

et al. 2019

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Background Migraine, tension‐type headache, and hypothyroidism constitute very common medical conditions. Headache is one of the most common symptoms of hypothyroidism, occurring in approximately one‐third of the patients. To date, data about the relationship between migraine and tension‐type headache and thyroid dysfunction, and in particular hypothyroidism have been contradictory, while the underlying pathophysiological basis explaining this association is still unclear. Objective In this review, we investigated the association between primary headaches and hypothyroidism, with the aim of shedding light on its pathophysiological basis. Methods We conducted a systematic search in the MEDLINE database using both subject headings and keywords for headache, migraine, tension‐type headache, thyroid hormones, and hypothyroidism, and we also examined manually the reference lists of all articles that met the inclusion criteria. Included studies were related to headache and thyroid disease comorbidity, with emphasis on hypothyroidism (ideally demonstrated by hormonal measurements), and with the term headache including migraine, tension‐type headache, and headache attributed to hypothyroidism (HAH) based on the International Classification of Headache Disorders IIIb. Quality of studies was assessed by the Newcastle‐Ottawa scale. Results Of a total of 640 identified articles, 9 studies were included. Overall, there was vast heterogeneity across the included studies concerning population, study design and outcomes. Two studies investigated the HAH, with emphasis on the clinical characteristics of headache (time of onset, localization, quality, intensity, and response to hormonal replacement treatment). Five studies investigated comorbidity between migraine and thyroid disorders, especially hypothyroidism, and in the majority of them a positive association was demonstrated. One study found that headache, and particularly migraine, may increase the risk of developing hypothyroidism. Finally, only 1 study on chronic tension‐type headache found coexistence of migraine and hypoactivity of the hypothalamus‐pituitary‐thyroid axis. The strengths and limitations of these studies are analyzed and possible pathophysiological mechanisms are suggested. Conclusions The existing data are considered inadequate to answer with certainty the relationship between headaches and thyroid disorders. According to our analysis, it seems that suggestions for a possible bidirectional association between headaches and especially migraine and hypothyroidism could exist. It hence lays the foundation for further research into the aforementioned association and its pathogenesis via large prospective multicenter studies.

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Section: Discussionmentioning

confidence: 99%

Relationship of Migraine and Tension‐Type Headache With Hypothyroidism: A Literature Review

et al. 2019

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“…17 Since headaches linked to pituitary adenomas can mimic primary headache disorders, particularly the trigeminal autonomic cephalalgias, it is important to maintain a high index of clinical suspicion for a secondary process in a patient with refractory headaches. 3,15 If imaging fails to reveal an abnormality, there is benefit in a hormone panel and medical management with alternative pharmacotherapy than usually prescribed for headache.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple mechanisms have been proposed for pituitary adenomas causing CH-like attacks, including tumor invasion into adjacent areas, 3, 7 –9,15–17 mass effect/tumor size, 3,7,10,11,15,16 hormonal secretion, 3,15 –17 and inflammation or irritation of pain-sensitive structures, such as the meninges. 3,16,17 In our case and one other, 12 CH-like attacks were initially associated with normal imaging that later revealed a macroadenoma. Unlike our case, the other report was of a single type of headache with typical features of CH.…”

Section: Discussionmentioning

confidence: 99%

“…1 A variety of headache types can arise from pituitary tumors, including migraine, primary stabbing headache, and trigeminal autonomic cephalalgias, such as cluster headache (CH), hemicrania continua, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing. 2,3 Like pituitary adenomas, CH also has a prevalence of approximately 0.1%. 4 CH is characterized by severe or very severe unilateral attacks of the orbital, supraorbital, or temporal regions that last 15-180 min, occurs with a frequency ranging from once every day up to eight times a day, and is associated with at least one of the following signs and symptoms: ipsilateral conjunctival injection, lacrimation, nasal congestion, rhinorrhea, eyelid edema, forehead and facial hidrosis, miosis, ptosis, restlessness, or agitation.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A triad of cluster-like headaches with delayed development of a macroscopic prolactinoma: A case report

Ihezie

Chandalia

Burish

2020

Cephalalgia Reports

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Pituitary hormone testing is recommended in refractory cluster headache (CH), but supporting evidence is limited. We present a patient with cluster-like headaches and a negative brain magnetic resonance imaging (MRI) 1 year after headache onset. He failed multiple medication trials. Three years after headache onset, additional workup showed abnormal pituitary labs including hyperprolactinemia and a brain MRI with a 15 × 15 × 14 mm3 enhancing pituitary lesion. With cabergoline 0.25 mg twice weekly, the patient has been headache-free for over 2 years. This case supports the recommendations for pituitary testing in refractory CH, even if imaging is initially negative for a pituitary tumor.

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Characteristics of pain in patients with pituitary adenomas: A cross‐sectional study

Dallel

Devoize

Tauveron

et al. 2021

European Journal of Pain

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Background This study determines the prevalence and particularities of headache and pain with neuropathic characteristics (NC) in a large French group of patients with pituitary adenoma (PA). Methods Analysis of validated self‐administered questionnaires, radiological characteristics and treatment strategies of PA was performed. Results Of the 221 sent questionnaires, 146 could be used for statistical analysis, 50% of which were completed by women. Among responders, 58.9% had pain: 30.1% migraine, 15.7% pain with NC and 13.1% other types of pain. Migraine was more common in patients with PA than in the general population (30.1% vs. 21.3%, p = .010) and attacks received appropriate treatment for less than 20% of these patients. Furthermore, the prevalence of chronic migraine was much higher than in the general population (6.8% vs. 2.2%, p = .003). Neuropathic pain was also more frequent in PA patients than in the general population (15.8% vs. 6.9%, p < .001). Neuropathic pain was most often located in the extremities and was frequently described as an ‘electric shock’, ‘numbness’, or ‘pins‐and‐needles’. Multivariate analyses linked migraine to younger age, anxiety, pain with NC, and a visible tumour on MRI, regardless of its invasiveness or secretory nature. Conclusions Migraine headaches and neuropathic pain are more frequent and disabling in PA patients than in the general population. Both types of pain are comorbid in PA patients and are poorly treated. Migraine is associated with the presence of a tumour. Thus, biological mechanisms of this relationship need to be characterized to design optimal treatments for these individuals. Significance Migraine headaches and neuropathic pain are more common in PA patients than in the general population and are generally poorly treated. A systematic screening for migraine should be done by physicians in daily practice to provide adequate therapeutics.

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Clinical Presentation and Management of Headache in Pituitary Tumors

Cited by 19 publications

References 56 publications

Relationship of Migraine and Tension‐Type Headache With Hypothyroidism: A Literature Review

Relationship of Migraine and Tension‐Type Headache With Hypothyroidism: A Literature Review

A triad of cluster-like headaches with delayed development of a macroscopic prolactinoma: A case report

Characteristics of pain in patients with pituitary adenomas: A cross‐sectional study

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