Department of Neurology, University of Munich Hospital - Grosshadern, Germany.
Cephalalgia. 2012 Dec;32(16):1198-207. doi: 10.1177/0333102412462639. Epub 2012 Oct 11.
The aim of this article is to generate hypotheses for the mechanism of pituitary adenoma headache.
Fifty-eight patients with pituitary adenoma were prospectively analysed for prevalence and manifestation of tumour headache. Intrapersonal and neoplasm-associated risk factors were assessed.
Twenty-four patients (41%) had tumour-attributed headache, seven had migraine-like, 11 tension-type headache-like headache, and three both. Cluster headache-like headache was found once, and two headaches remained unclassified. Tumour-attributed headache was associated with a positive history of headache (p = 0.03; OR 3.4), nicotine abuse (p < 0.01; OR 4.7), intake of acute headache medication (p = 0.04; OR 3.3), and a higher tumour proliferation indicated by a Ki67-labelling index (LI) >3% (p = 0.02; OR 11.0). For patients with migraine-like tumour-attributed headache, risk factors were younger age (p = 0.02), nicotine abuse (p < 0.01; OR 10.9), acute headache treatment (p < 0.01; OR 9.0), and Ki67-LI >3% (p = 0.03; OR 14.1). For tension-type headache-like headache, the main risk factor was a positive history of tension-type headache (p = 0.045; OR 5.6).
Headache predisposition and local tumour effects might be important for the pathophysiology of pituitary adenoma headache and tumour headache in general.
本文旨在提出垂体腺瘤头痛的发病机制假说。
前瞻性分析了 58 例垂体腺瘤患者的肿瘤头痛发生率和表现，评估了个体和肿瘤相关的危险因素。
24 例（41%）患者存在与肿瘤相关的头痛，7 例为偏头痛样头痛，11 例为紧张型头痛样头痛，3 例同时存在偏头痛样和紧张型头痛样头痛。偶发性丛集性头痛样头痛 1 例，2 例头痛类型无法分类。与肿瘤相关的头痛与头痛病史阳性（p = 0.03；OR 3.4）、尼古丁滥用（p < 0.01；OR 4.7）、急性头痛治疗（p = 0.04；OR 3.3）和 Ki67 标记指数（LI）>3%（p = 0.02；OR 11.0）提示肿瘤增殖程度较高有关。对于偏头痛样的与肿瘤相关的头痛，主要的危险因素是年龄较小（p = 0.02）、尼古丁滥用（p < 0.01；OR 10.9）、急性头痛治疗（p < 0.01；OR 9.0）和 Ki67-LI >3%（p = 0.03；OR 14.1）。对于紧张型头痛样头痛，主要的危险因素是紧张型头痛病史阳性（p = 0.045；OR 5.6）。
头痛易感性和局部肿瘤效应可能对垂体腺瘤头痛和一般肿瘤性头痛的病理生理学具有重要意义。
