Skip to main content

Advertisement

SpringerLink
Log in

Presence of headache and headache types in patients with tumors of the sellar region—can surgery solve the problem? Results of a prospective single center study

  • Original Article
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Purpose

Headache is a common presenting feature of patients with pituitary adenomas and other tumors of the sellar region. However, at present, it still is unclear whether the headache is actually caused by the tumor. To explore whether there is a relation, we examined in detail the headache types, their relationship to the underlying pathology, and if the headache responded to neurosurgery in a prospective study design.

Methods

One hundred twelve patients with tumors of the sellar region scheduled for neurosurgery in a single center were analyzed for presence and quality of headache before surgery and at least 3 months after surgery. Patients received headache and depression self-rating inventories, presented on a handheld computer (PainDetect®). Clinical variables thought to impact on headache were analyzed in conjunction with the inventories.

Results

Fifty-nine (53%) patients reported headache in the 3 months prior to neurosurgery, 49 (44%) had headache at the time of filling in the questionnaires. The four patients with pituitary apoplexy described thunderclap headache. In the other patients diverse headache types were encountered, most frequently migraine. Untreated gonadotroph deficiency was significantly associated with absence of headache, while none of the other clinical and morphological variables related to headache. Presence of headache and disability due to headache were not significantly reduced after surgery.

Conclusion

Apart from pituitary apoplexy we detected no specific headache type in our patient group and no significant improvement of headache after neurosurgery. Headache alone constitutes neither a valid diagnostic marker for the presence of tumors of the sellar region nor a sufficient indication for tumor removal.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. A. Jahangiri, J.R. Wagner, A.T. Chin, S.W. Han, M.T. Tran, L.M. Miller, M.W. Tom, R. Chen, S. Kunwar, L. Blevins, M.K. Aghi, Incidence of headache as a presenting complaint in over 1000 patients with sellar lesions and factors predicting postoperative improvement. Clin. Neurol. Neurosurg. 132, 16–20 (2015). doi:10.1016/j.clineuro.2015.02.006

    Article  PubMed  Google Scholar 

  2. M.J. Levy, M.S. Matharu, K. Meeran, M. Powell, P.J. Goadsby, The clinical characteristics of headache in patients with pituitary tumours. Brain 128(Pt 8), 1921–1930 (2005). doi:10.1093/brain/awh525

    Article  CAS  PubMed  Google Scholar 

  3. B. Stoffel-Wagner, P. Stoger, D. Klingmuller, Initial symptoms and anamnestic time in 517 patients with pituitary adenoma. Dtsch. Med. Wochenschr. 122(8), 213–219 (1997). doi:10.1055/s-2008-1047599

    Article  CAS  PubMed  Google Scholar 

  4. B.M. Arafah, D. Prunty, J. Ybarra, M.L. Hlavin, W.R. Selman, The dominant role of increased intrasellar pressure in the pathogenesis of hypopituitarism, hyperprolactinemia, and headaches in patients with pituitary adenomas. J. Clin. Endocrinol. Metab. 85(5), 1789–1793 (2000). doi:10.1210/jcem.85.5.6611

    Article  CAS  PubMed  Google Scholar 

  5. J.A. Gondim, J.P. de Almeida, L.A. de Albuquerque, M. Schops, E. Gomes, T. Ferraz, Headache associated with pituitary tumors. J. Headache Pain 10(1), 15–20 (2009). doi:10.1007/s10194-008-0084-0

    Article  PubMed  Google Scholar 

  6. M.J. Levy, The association of pituitary tumors and headache. Curr. Neurol. Neurosci. Rep. 11(2), 164–170 (2011). doi:10.1007/s11910-010-0166-7

    Article  PubMed  Google Scholar 

  7. A. Pereira-Neto, A.M. Borba, P.A. Mello, L.A. Naves, A.S. Araujo Jr, L.A. Casulari, Mean intrasellar pressure, visual field, headache intensity and quality of life of patients with pituitary adenoma. Arq. Neuropsiquiatr. 68(3), 350–354 (2010)

    Article  Google Scholar 

  8. N. Suwanwela, K. Phanthumchinda, S. Kaoropthum, Headache in brain tumor: a cross-sectional study. Headache 34(7), 435–438 (1994)

    Article  CAS  Google Scholar 

  9. The International Classification of Headache Disorders: 2nd edition, Headache Classification Subcommittee of the International Headache Society. Cephalalgia 24(Suppl 1), 9–160 (2004)

  10. S. Nelson, L.P. Taylor, Headaches in brain tumor patients: primary or secondary? Headache 54(4), 776–785 (2014). doi:10.1111/head.12326

    Article  PubMed  Google Scholar 

  11. Z. Morris, W.N. Whiteley, W.T. Longstreth Jr., F. Weber, Y.C. Lee, Y. Tsushima, H. Alphs, S.C. Ladd, C. Warlow, J.M. Wardlaw, R. Al-Shahi Salman, Incidental findings on brain magnetic resonance imaging: systematic review and meta-analysis. Br. Med. J. 339, b3016 (2009). doi:10.1136/bmj.b3016

    Article  Google Scholar 

  12. C.J. Schankin, A.K. Reifferscheid, M. Krumbholz, J. Linn, W. Rachinger, S. Langer, P. Sostak, T. Arzberger, H. Kretzschmar, A. Straube, Headache in patients with pituitary adenoma: clinical and paraclinical findings. Cephalalgia 32(16), 1198–1207 (2012). doi:10.1177/0333102412462639

    Article  PubMed  Google Scholar 

  13. Department of Health and Human Services, F.D.A., in International Conference on Harmonisation; Good Clinical Practice: Consolidated Guideline, Vol. 62, pp. 1–53. Federal Register, Brussels, Belgium (1997)

  14. World Medical Association, World medical association declaration of Helsinki: ethical principles for medical research involving human subjects. J. Am. Med. Assoc. 310(20), 2191–2194 (2013). doi:10.1001/jama.2013.281053

    Article  CAS  Google Scholar 

  15. U. Junker, R. Freynhagen, K. Langler, U. Gockel, U. Schmidt, T.R. Tolle, R. Baron, T. Kohlmann, Paper versus electronic rating scales for pain assessment: a prospective, randomised, cross-over validation study with 200 chronic pain patients. Curr. Med. Res. Opin. 24(6), 1797–1806 (2008). doi:10.1185/03007990802121059

    Article  PubMed  Google Scholar 

  16. M. Pompili, D. Di Cosimo, M. Innamorati, D. Lester, R. Tatarelli, P. Martelletti, Psychiatric comorbidity in patients with chronic daily headache and migraine: a selective overview including personality traits and suicide risk. J. Headache Pain 10(4), 283–290 (2009). doi:10.1007/s10194-009-0134-2

    Article  PubMed  PubMed Central  Google Scholar 

  17. G. Fritsche, M. Hueppe, M. Kukava, A. Dzagnidze, M. Schuerks, M.S. Yoon, H.C. Diener, Z. Katsarava, Validation of a German language questionnaire for screening for migraine, tension-type headache, and trigeminal autonomic cephalgias. Headache 47(4), 546–551 (2007). doi:10.1111/j.1526-4610.2007.00758.x

    Article  PubMed  Google Scholar 

  18. W.F. Stewart, R.B. Lipton, A.J. Dowson, J. Sawyer, Development and testing of the migraine disability assessment (MIDAS) questionnaire to assess headache-related disability. Neurology 56(6 Suppl 1), S20–S28 (2001)

    Article  CAS  Google Scholar 

  19. K. Kroenke, R.L. Spitzer, J.B. Williams, The PHQ-9: validity of a brief depression severity measure. J. Gen. Intern. Med. 16(9), 606–613 (2001)

    Article  CAS  Google Scholar 

  20. A. Victor, A. Elsasser, G. Hommel, M. Blettner, Judging a plethora of p-values: how to contend with the problem of multiple testing—part 10 of a series on evaluation of scientific publications. Dtsch. Arztebl. Int. 107(4), 50–56 (2010). doi:10.3238/arztebl.2009.0050

    Article  PubMed  PubMed Central  Google Scholar 

  21. B. Yu, N. Ji, Y. Ma, B. Yang, P. Kang, F. Luo: Clinical characteristics and risk factors for headache associated with non-functioning pituitary adenomas. Cephalalgia (2016). doi:10.1177/0333102416648347

  22. M.J. Levy, H.R. Jager, M. Powell, M.S. Matharu, K. Meeran, P.J. Goadsby, Pituitary volume and headache: size is not everything. Arch. Neurol. 61(5), 721–725 (2004). doi:10.1001/archneur.61.5.721

    Article  PubMed  Google Scholar 

  23. C. Dimopoulou, A.P. Athanasoulia, E. Hanisch, S. Held, T. Sprenger, T.R. Toelle, J. Roemmler-Zehrer, J. Schopohl, G.K. Stalla, C. Sievers, Clinical characteristics of pain in patients with pituitary adenomas. Eur. J. Endocrinol. 171(5), 581–591 (2014). doi:10.1530/eje-14-0375

    Article  CAS  PubMed  Google Scholar 

  24. B. Harbeck, C.S. Haas, S. Suefke, P. Kropp, H. Moenig, Headache and depression in patients with hypothalamic-pituitary disorders-etiology and risk factors. Exp. Clin. Endocrinol. Diabetes 123(9), 571–574 (2015). doi:10.1055/s-0035-1559630

    Article  CAS  PubMed  Google Scholar 

  25. N.C. Chai, B.L. Peterlin, A.H. Calhoun, Migraine and estrogen. Curr. Opin. Neurol. 27(3), 315–324 (2014). doi:10.1097/wco.0000000000000091

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. T. Abe, K. Matsumoto, J. Kuwazawa, I. Toyoda, K. Sasaki, Headache associated with pituitary adenomas. Headache 38(10), 782–786 (1998)

    Article  CAS  Google Scholar 

  27. M.H. Almalki, A.D. Chesover, M.D. Johnson, G.E. Wilkins, J.A. Maguire, E. Ur, Characterization of management and outcomes of patients with acromegaly in Vancouver over 30 years. Clin. Invest. Med. 35(1), E27–E33 (2012)

    Article  Google Scholar 

  28. M. Mercado, A.L. Espinosa de los Monteros, E. Sosa, S. Cheng, V. Mendoza, I. Hernandez, C. Sandoval, G. Guinto, M. Molina, Clinical-biochemical correlations in acromegaly at diagnosis and the real prevalence of biochemically discordant disease. Horm. Res. 62(6), 293–299 (2004). doi:10.1159/000082032

    Article  CAS  PubMed  Google Scholar 

  29. D. Borsook, N. Erpelding, A. Lebel, C. Linnman, R. Veggeberg, P.E. Grant, C. Buettner, L. Becerra, R. Burstein, Sex and the migraine brain. Neurobiol. Dis. 68, 200–214 (2014). doi:10.1016/j.nbd.2014.03.008

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. A. May, L.H. Schulte, Chronic migraine: risk factors, mechanisms and treatment. Nat. Rev. Neurol. 12(8), 455–464 (2016). doi:10.1038/nrneurol.2016.93

    Article  CAS  PubMed  Google Scholar 

  31. M.T. Minen, O. Begasse De Dhaem, A. Kroon Van Diest, S. Powers, T.J. Schwedt, R. Lipton, D. Silbersweig, Migraine and its psychiatric comorbidities. J. Neurol. Neurosurg. Psychiatry 87(7), 741–749 (2016). doi:10.1136/jnnp-2015-312233

    Article  PubMed  Google Scholar 

  32. R.W. Evans, M.J. Levy, Expert opinion: headache and pituitary tumors. Headache 48(2), 280–283 (2008). doi:10.1111/j.1526-4610.2007.01020.x

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Part of the data was collected for the doctoral theses of Renata Weber Carneiro and Sonja Siegel. The study was performed when the first, second, fifth, and last author worked full-time at the Department of Neurosurgery, Erlangen. The study was partially funded by an independent investigator-initiated grant from Pfizer Pharma GmbH.

Author contributions

S.S., R.W.C., M.B., G.B., and I. K.-A. designed the study. R.W.C., S.S., and A.G. collected the data. S.S., B.K., and I. K.-A. conducted the statistical data analysis. All authors critically discussed the results of the study and participated in the drafting of the manuscript.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University of Duisburg-Essen, Hufelandstr. 55, Essen, 45147, Germany

    Sonja Siegel, Bernadette Kleist, Agnieszka Grzywotz & Ilonka Kreitschmann-Andermahr

  2. Siemens Healthcare GmbH, Henkestr, 127, Erlangen, 91052, Germany

    Renata Weber Carneiro

  3. Department of Neurosurgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Schwabachanlage 6, Erlangen, 91031, Germany

    Michael Buchfelder

  4. Institute of Neuropathology, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Schwabachanlage 6, Erlangen, 91031, Germany

    Rolf Buslei

  5. Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, Essen, 45147, Germany

    Ulrike Bingel

  6. Department of Internal Medicine I, University of Luebeck, Ratzeburger Allee 160, Luebeck, 23538, Germany

    Georg Brabant

  7. Department of Psychology, Ludwig-Maximilians University Munich, Leopoldstr. 13, Munich, 80802, Germany

    Thomas Schenk

Authors
  1. Sonja Siegel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Renata Weber Carneiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Buchfelder
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bernadette Kleist
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Agnieszka Grzywotz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rolf Buslei
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ulrike Bingel
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Georg Brabant
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Thomas Schenk
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ilonka Kreitschmann-Andermahr
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ilonka Kreitschmann-Andermahr.

Ethics declarations

Conflict of interest

With respect to the performed research, the authors report no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Siegel, S., Weber Carneiro, R., Buchfelder, M. et al. Presence of headache and headache types in patients with tumors of the sellar region—can surgery solve the problem? Results of a prospective single center study. Endocrine 56, 325–335 (2017). https://doi.org/10.1007/s12020-017-1266-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-017-1266-9

Keywords

Search

Navigation