Headache Before and After Endoscopic Transsphenoidal Pituitary Tumor Surgery: A Prospective Study

Abstract

Objective Headache is a common symptom among patients with pituitary tumors, as it is in the general population. The aim of the study was to investigate headache as a symptom in patients with pituitary tumors before and 6 months after endoscopic transsphenoidal surgery (TSS). Design This is a prospective observational cohort study. Setting This study was conducted at university tertiary referral hospital. Participants A total of 110 adult patients underwent endoscopic TSS for pituitary tumors. Main Outcome Measures The Migraine Disability Assessment (MIDAS) questionnaire was used before and 6 months after surgery for the assessment of headache. Clinical variables with potential influence on headache were analyzed. Results Sixty-eight (62%) patients experienced headaches at least once during the 3 months before surgery. Thirty (27%) patients reported disabling headache before surgery, with younger age being an independent associated factor (p < 0.001). In patients with disabling headache before surgery, the median (interquartile range) MIDAS score improved from 78 (27–168) to 16 (2–145; p = 0.049), headache frequency decreased from 45 (20–81) to 14 (4–35) days (p = 0.009), and headache intensity decreased from 6 (5–8) to 5 (4–7) (p = 0.011) after surgery. In total, 16 of the 30 (53%) patients reported a clinically relevant improvement and five (17%) a clinically relevant worsening. Four (5%) patients developed new disabling headache. No predictor for postoperative improvement of headache was identified. Conclusion In this prospective study, the results show that disabling headache improves following endoscopic TSS in a subset of patients with pituitary tumors. However, no predictive factors for improvement could be identified.

Headache in patients with non-functioning pituitary adenoma before and after transsphenoidal surgery – a prospective study

“…However, our findings of improved headache postsurgery in a significant number of patients suggest that their status according to the International Classification of Headache Disorders ICHD-3 criteria [22] qualified them as presenting pituitary tumor-associated headache prior to surgery. Our results agree with previous studies showing similar post-surgical improvements (49-81%) [10,15,30,36] and deteriorations in symptoms (8-17%) [7,15,36]. These findings offer important information that should be provided to patients during preoperative assessment regarding Although these results agree with two previous prospective studies of similar sizes [15,16], the present study focused on a more homogenous cohort comprising only patients with NFPAs and across a longer follow-up time of 12 months.…”

“…Our results agree with previous studies showing similar post-surgical improvements (49-81%) [10,15,30,36] and deteriorations in symptoms (8-17%) [7,15,36]. These findings offer important information that should be provided to patients during preoperative assessment regarding Although these results agree with two previous prospective studies of similar sizes [15,16], the present study focused on a more homogenous cohort comprising only patients with NFPAs and across a longer follow-up time of 12 months. Other smaller studies have also reported similar findings, two of them using headache evaluations before and 6-months after surgery using the Headache Impact Test (HIT)-6 [7,8].…”

“…Our results showed that younger age and Ki-67 > 3% was associated with disabling headache before surgery in univariable analysis. Other previous studies of patients with pituitary tumors and headache have shown similar relationships between patient age [2,12,15,30], age and Ki-67 level [13,31]; however, in our multivariable analysis, only younger age was independently associated with headache.…”

“…The first five questions measure the impact of headache on daily living by evaluating the number of days during a 3-month period that headache resulted in the following: (1) missed work, (2) 50% reduction in work productivity (apart from the days from question 1), (3) inability to perform household tasks, (4) 50% reduction in household productivity (apart from the days from question 3), and (5) inability to participate in family and social activities. Patient responses result in a score (maximum score: 270) that grades patient disability as follows for each question: Grade I (0-5), "little to no disability"; Grade II (6-10) "mild disability"; Grade III (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), "moderate disability"; and Grade IV (21 or higher) "severe disability". A MIDAS grade ≥ II suggests a headache as disabling [18].…”

“…Although several studies report significant improvement of headache following TSS, most of them are limited by small cohorts, often representing various adenoma etiologies or a short post-surgical follow-up time [7,8,13]. A previous study on 110 patients with both NFPA and functioning pituitary adenomas, based on the Gothenburg Pituitary Tumor Study (GoPT) [14], reported improvements in disabling headache at 6-months following TSS [15]. Another recent prospective study on 122 patients with both NFPA and functioning pituitary adenomas, and the same follow-up time, reported comparable results [16].…”