Headache in Patients With Pituitary Lesions: A Longitudinal Cohort Study

Abstract BACKGROUND: Headache is a presenting feature in 37% to 70% of patients with pituitary tumor. Other pituitary lesions may also present with headache, and together these lesions account for about 20% of all primary brain lesions. Although pituitary lesions have been associated with headache, the exact nature of the relationship remains undefined. It is not always clear whether the presenting headache is an unrelated primary headache, a lesion-induced aggravation of a preexisting primary headache, or a separate secondary headache related to the lesion. OBJECTIVE: To characterize headache in patients referred to a multidisciplinary neuroendocrine clinic with suspected pituitary lesions and to assess changes in headache in those who underwent surgery. METHODS: We used a self-administered survey of headache characteristics completed by patients upon presentation and after any pituitary surgical procedure. RESULTS: One hundred thirty-three participants completed the preoperative questionnaire (response rate of 99%). The overall prevalence of headache was 63%. Compared to patients without headache, the group with headache was more likely to be female (P = .001), younger (P = .001), and to have had a prior headache diagnosis (P < .001). Seventy-two percent of patients reported headache localized to the anterior region of the head. Fifty-one patients with headache underwent transsphenoidal pituitary surgery. Headache was not associated with increased odds of having surgery (odds ratio, 0.90). At 3 months, 81% of surgically treated patients with headache who completed the postoperative questionnaire (21/26) reported improvement or resolution of headaches. No patient who completed the postoperative questionnaire (44/84) reported new or worsened headache. CONCLUSION: Frequent, disabling headaches are common in patients with pituitary lesions referred for neuroendocrine consultation, especially in younger females with a preexisting headache disorder. Surgery in this group was associated with headache improvement or resolution in the majority and was not found to cause or worsen headaches. Suggestions for revision of the International Classification of Headache Disorders diagnostic criteria pertaining to pituitary disorders are supported by these findings.

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Headaches: new classification, clinical and diagnostic criteria in General Medicine

Clinical Management Issues ◽

10.7175/cmi.v8i3.899 ◽

2014 ◽

Vol 8 (3) ◽

pp. 67-74

Author(s):

Linda Iurato

Keyword(s):

International Headache Society ◽

General Medicine ◽

Primary Headache ◽

Secondary Headache ◽

Headache Disorders ◽

First Line ◽

Primary Headache Disorders ◽

Headache Diagnosis ◽

Beta Version

The classification system of headaches is one of the oldest in medicine, and includes a hugeamount of types and causes. The International Headache Society has listed two broad categoriesfor headache disorders: primary headache disorders, which lack a clear underlying causativepathology, and secondary headache disorders, that have a known cause. This is an overviewaddressed to general practitioners to help making a first-line headache diagnosis basing on themost common types of headache listed in the 2013 International Classification of Headachedisorder 3rd edition (beta version). Although headache diagnosis and treatment have madesubstantial gains in the last decade, the disease is still underdiagnosed and undertreated:improvements in several areas are required, especially in General Medicine.

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Characteristics of Brain Tumour-Associated Headache

Cephalalgia ◽

10.1111/j.1468-2982.2007.01368.x ◽

2007 ◽

Vol 27 (8) ◽

pp. 904-911 ◽

Cited By ~ 75

Author(s):

CJ Schankin ◽

U Ferrari ◽

VM Reinisch ◽

T Birnbaum ◽

R Goldbrunner ◽

...

Keyword(s):

Brain Tumour ◽

Univariate Analysis ◽

Positive Family History ◽

Primary Headache ◽

Tension Type Headache ◽

Moderate Intensity ◽

Secondary Headache ◽

History Of ◽

Type Headache

Eighty-five brain tumour patients were examined for further characteristics of brain tumour-associated headache. The overall prevalence of headache in this population was 60%, but headache was the sole symptom in only 2%. Pain was generally dull, of moderate intensity, and not specifically localized. Nearly 40% met the criteria of tension-type headache. An alteration of the pain with the occurrence of the tumour was experienced by 82.5%, implying that the preexisting and the brain tumour headaches were different. The classic characteristics mentioned in the International Classification of Headache Disorders (worsening in the morning or during coughing) were not found; this might be explained by the patients not having elevated intracranial pressure. Univariate analysis revealed that a positive family history of headache and the presence of meningiomas are risk factors for tumour-associated headache, and the use of β-blockers is prophylactic. Pre-existing headache was the only risk factor according to logistic regression, suggesting that patients with pre-existing (primary) headache have a greater predisposition to develop secondary headache. Dull headache occurs significantly more often in patients with glioblastoma multiforme, and pulsating headache in patients with meningioma. In our study, only infratentorial tumours were associated with headache location, and predominantly with occipital but rarely frontal pain.

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Headache in Sports

10.1093/oxfordhb/9780199896585.013.19 ◽

2016 ◽

Author(s):

Tad Seifert

Keyword(s):

Primary Headache ◽

Headache Disorder ◽

Epidemiological Data ◽

Return To Play ◽

Secondary Headache ◽

Headache Disorders ◽

Unique Challenge ◽

Primary Headache Disorder ◽

Primary Headache Disorders ◽

Headache Type

The prevalence of primary headache disorders in the general population provides a unique challenge in the evaluation of headache occurring in the context of sport. Sport-related and exercise-related headaches are not uncommon, but there is limited epidemiological data on these types of headaches in athletes. Any primary headache type can occur in the setting of sports. These scenarios are challenging in the return to play context, as it is often unclear whether an athlete has an exacerbation of a primary headache disorder, new onset headache unrelated to trauma, or has suffered a genuine concussive injury. Through careful evaluation, the practitioner can distinguish primary headache disorders from posttraumatic headaches following concussion. This chapter reviews primary headache disorders, posttraumatic headaches, and other secondary headache disorders.

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Revised 2004 International Classification of Headache Disorders: New Headache Types

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s031716710000336x ◽

2004 ◽

Vol 31 (3) ◽

pp. 304-314 ◽

Cited By ~ 12

Author(s):

Jonathan P. Gladstone ◽

David W. Dodick

Keyword(s):

Treatment Guidelines ◽

International Headache Society ◽

Genetic Research ◽

Primary Headache ◽

Current Treatment ◽

International Classification ◽

Secondary Headache ◽

Headache Disorders ◽

Primary Headache Disorders

In 1988, the International Headache Society created a classification system that has become the standard for headache diagnosis and research. The International Classification of Headache Disorders galvanized the headache community and stimulated nosologic, epidemiologic, pathophysiologic, and genetic research. It also facilitated multinational clinical drug trials that have led to the basis of current treatment guidelines. While there have been criticisms, the classification received widespread support by headache societies around the globe. Fifteen years later, the International Headache Society released the revised and expanded International Classification of Headache Disorders second edition. The unprecedented and rapid advances in the field of headache led to the inclusion of many new primary and secondary headache disorders in the revised classification. Using illustrative cases, this review highlights 10 important new headache types that have been added to the second edition. It is important for neurologists to familiarize themselves with the diagnostic criteria for the frequently encountered primary headache disorders and to be able to access the classification (www.i-h-s.org) for the less commonly encountered or diagnostically challenging presentations of headache and facial pain.

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Headache associated with head trauma

Oxford Textbook of Headache Syndromes ◽

10.1093/med/9780198724322.003.0035 ◽

2020 ◽

pp. 314-321

Author(s):

Sylvia Lucas

Keyword(s):

Primary Headache ◽

Headache Disorder ◽

Standard Of Care ◽

Temporal Association ◽

Prior History ◽

Secondary Headache ◽

Primary Headache Disorder ◽

Global Health Issue ◽

History Of ◽

Probable Migraine

Traumatic brain injury (TBI) is an extremely important, common global health issue with approximately 2.5 million TBIs occurring yearly in the civilian population alone. The symptom manifestations of TBI are called ‘concussion’ symptoms and headache is the most common. Post-traumatic headache (PTH) is a secondary headache occurring in temporal association with the TBI and thought to be caused by the injury. Many studies have found PTH to be frequent and persistent, with a higher prevalence of PTH after mild than moderate to severe TBI. In both severity injuries, the most frequent phenotype of PTH is migraine or probable migraine. PTH risk factor after injury is a prior history of primary headache disorder. The relationship between TBI and PTH is unknown and currently the subject of intense research. As yet, treatment of PTH is empiric with standard of care to ‘phenotype’ the headache according to primary headache clinical characteristics and use the type as a guideline for management.

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Drug-induced headache: an analysis of therapeutic strategies

Neurology neuropsychiatry Psychosomatics ◽

10.14412/2074-2711-2020-4-25-31 ◽

2020 ◽

Vol 12 (4) ◽

pp. 25-31

Author(s):

P. A. Merbaum ◽

G. R. Tabeeva ◽

A. V. Sergeev

Keyword(s):

Tension Headache ◽

Primary Headache ◽

Developed Countries ◽

Secondary Headache ◽

Drug Induced ◽

Treatment And Prevention ◽

Symptomatic Headache ◽

Drug Induced Headache

To manage patients with drug-induced headache (DIH) is an unsolved problem of modern neurology in developed countries, since DIH is becoming a common cause of temporary disability and leads to lower quality of life in patients. Patients with primary headache (for example, those with tension headache or migraine) frequently take symptomatic headache relief medications uncontrollably, which can result in the higher frequency and intensity of DIH episodes. In turn, new headache attacks make the patients take the increasing number of symptomatic medications, which leads to the development of DIH.The International Classification of Headache Disorders, 3 rd Edition, defines DIH as a distinct form of secondary headache. To date, there is no consensus on the tactics of DIH treatment and prevention. The paper discusses different approaches to DIH prevention and treatment, the effectiveness and appropriateness of their use, as well as factors influencing illness course and possible outcomes. Particular attention is paid to the management of patients during the withdrawal period, risk factors for DIH recurrences, and ways of their prevention.

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Headache in the Emergency Department in Chongqing Province, China: A Multicentre Study

10.21203/rs.3.rs-126680/v1 ◽

2020 ◽

Author(s):

Qin Li ◽

Tao Ye ◽

Jingxi Ma ◽

Dongli Yuan ◽

Xuemei Peng ◽

...

Keyword(s):

Emergency Department ◽

Primary Headache ◽

Secondary Headache ◽

General Hospitals ◽

Course Of Disease ◽

Hospitalization Rates ◽

Diagnosis Rate ◽

Missed Diagnosis ◽

Male Patients

Abstract Background: To investigate the present situation of emergency headache in many general hospitals in Chongqing Province, China.Methods: From January 1 to December 31, 2017, we studied patients who complained of headaches as the main symptom in the emergency department of 17 general hospitals in Chongqing Province. Each patient with a headache was interviewed and the medical history was collected by administering a questionnaire. The diagnosis of headache is based on the third edition of the International Classification of Headache Disorders (ICHD-3 beta). Results: In 2017, 16434 patients complained of headache in 17 general hospitals in Chongqing, accounting for 2.3% of all emergency patients. Eight thousand one male patients (48.7%) and 8433 female patients (51.3%) experienced a headache. The average age was (41.8 ± 13.2) years, and the course of disease was 3 hours to 15.2 years. Regarding the initial diagnosis, 7299 patients (44.4%) were diagnosed secondary headache, 5076 (30.9%) were diagnosed with primary headache and 4059 (24.865%) could not be diagnosed. The hospitalization rates for these patients were 60.3%, 12.2%, and 41.5%, respectively. Migraine is still the most common type of primary headache. Conclusions: This study shows that the misdiagnosis rate and missed diagnosis rate of patients with an emergency headache are high, and the emergency department still performs overtesting and hospitalizations.

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HUBUNGAN KUALITAS TIDUR DENGAN JENIS NYERI KEPALA PRIMER PADA SISWA-SISWI SMA NEGERI 1 PADANG

Human Care Journal ◽

10.32883/hcj.v5i2.789 ◽

2020 ◽

Vol 5 (2) ◽

pp. 560

Author(s):

Priyanka Prima Putri ◽

Restu Susanti ◽

Gusti Revilla

Keyword(s):

Sleep Quality ◽

Quality Index ◽

Pittsburgh Sleep Quality Index ◽

Primary Headache ◽

Headache Disorder ◽

Tension Type Headache ◽

Chi Square ◽

Cross Sectional ◽

Type Headache

AbstractPrimary headache is the most common complaint found in adolescents. Primary headache can be triggered by several factors, one of them is bad sleep quality. Both are the most experienced problems in adolescents which can decrease academic and non-academic productivity in schools. The aim of this study was to detemine the association between sleep quality and primary headache in students of SMA Negeri 1 Padang. This study was analytic study with cross sectional design. The sampling was done by purposive sampling technique and obtained 90 sampels. The diagnosis of primary headache was based on the headahe consensus of PERDOSSI 2018 which was corresponding with 3rd Edition of International Classification of Headache Disorder (Beta version). The data of sleep quality was collected by using The Pittsburgh Sleep Quality Index questionnaire. The data was analyzed by using Chi-Square test. The results showed that the majority of respondents were women (70%). The most common sleep quality was poor (67,8%). The most common type of headache was tension-type headache (78,9%). There was a significant relationship between sleep quality and the type of primary headache, which is tension type headache with moderate correlation (p <0.001 and r = 0.454) and migraine with low correlation (p=0,022 and r=0,311). It can be concluded from this study that bad sleep quality will increase the probability of suffering primary headacheKeywords: Sleep quality, primary headache, adolescents AbstrakNyeri kepala primer merupakan keluhan yang sering dijumpai pada remaja. Nyeri kepala primer dipicu oleh beberapa faktor, salah satunya adalah kualitas tidur yang buruk. Keduanya merupakan masalah yang sering dialami remaja yang dapat menurunkan produktivitas akademik dan non-akademik di sekolah. Tujuan dari penelitian ini adalah untuk mengetahui apakah terdapat hubungan antara kualitas tidur dengan nyeri kepala primer pada siswa-siswi SMA Negeri 1 Padang. Jenis penelitian ini adalah penelitian analitik dengan desain cross sectional. Pengambilan sampel dilakukan dengan teknik purposive sampling dan didapatkan sampel sebanyak 90 sampel. Diagnosis nyeri kepala primer berdasarkan konsensus nyeri kepala PERDOSSI tahun 2018 yang sesuai dengan International Classification of Headache Disorder Edisi 3 (versi beta). Data kualitas tidur dikumpulkan menggunakan kuesioner The Pittsburgh Sleep Quality Index. Analisis data menggunakan uji Chi-Square. Hasil penelitian menunjukkan sebagian besar responden adalah perempuan (70%). Kualitas tidur terbanyak yaitu buruk (67,8%). Jenis nyeri kepala primer terbanyak adalah nyeri kepala tipe tegang (78,9%). Terdapat hubungan yang bermakna antara kualitas tidur dengan jenis nyeri kepala primer yaitu nyeri kepala tipe tegang dengan korelasi sedang (p<0,001 dan r= 0,454) dan migrain dengan korelasi lemah (p=0,022 dan r=0,311). Berdasarkan penelitian ini dapat disimpulkan bahwa kualitas tidur buruk akan meningkatkan kemungkinan mengalami nyeri kepala primer.Kata kunci: Kualitas tidur, nyeri kepala primer, remaja

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Modular Headache Theory

Cephalalgia ◽

10.1046/j.1468-2982.2001.218254.x ◽

2001 ◽

Vol 21 (8) ◽

pp. 842-849 ◽

Cited By ~ 47

Author(s):

WB Young ◽

MFP Peres ◽

TD Rozen

Keyword(s):

Primary Headache ◽

Headache Disorder ◽

Secondary Headache ◽

Primary Headache Disorder ◽

Headache Patients

Many people experience headaches that do not fulfil the International Headache Society's criteria for a specific headache disorder yet behave biologically like that disorder. Others fulfil criteria for one headache disorder and yet have features of another disorder. To explain these observations, we propose that groups of neurones called modules become activated to produce each symptom of a primary headache disorder, and that each module is linked to other modules that together produce an individual's headache. This theory has implications for the classification, research and treatment of primary and secondary headache patients.

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Cluster Headache: Evidence for a Disorder of Circadian Rhythm and Hypothalamic Function

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100001694 ◽

2002 ◽

Vol 29 (1) ◽

pp. 33-40 ◽

Cited By ~ 56

Author(s):

Tamara Pringsheim

Keyword(s):

Circadian Rhythm ◽

Cluster Headache ◽

Suprachiasmatic Nucleus ◽

Biological Clock ◽

Primary Headache ◽

Headache Disorder ◽

Primary Headache Disorders ◽

Hypothalamic Function ◽

The Relationship ◽

Further Development

This article reviews the literature for evidence of a disorder of circadian rhythm and hypothalamic function in cluster headache. Cluster headache exhibits diurnal and seasonal rhythmicity. While cluster headache has traditionally been thought of as a vascular headache disorder, its periodicity suggests involvement of the suprachiasmatic nucleus of the hypothalamus, the biological clock. Normal circadian function and seasonal changes occurring in the suprachiasmatic nucleus and pineal gland are correlated to the clinical features and abnormalities of circadian rhythm seen in cluster headache. Abnormalities in the secretion of melatonin and cortisol in patients with cluster headache, neuroimaging of cluster headache attacks, and the use of melatonin as preventative therapy in cluster headache are discussed in this review. While the majority of studies exploring the relationship between circadian rhythms and cluster headache are not new, we have entered a new diagnostic and therapeutic era in primary headache disorders. The time has come to use the evidence for a disorder of circadian rhythm in cluster headache to further development of chronobiotics in the treatment of this disorder.

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