Department of Neurology, Georgetown University Medical Center, Washington DC, USA.
Department of Neurology, MedStar Georgetown University Hospital, Washington DC, USA.
Curr Pain Headache Rep. 2018 Jun 15;22(8):55. doi: 10.1007/s11916-018-0710-8.
This article provides an overview of headache in the setting of pituitary adenoma. The purpose of this article is to educate providers on the association, possible pathophysiology, and the clinical presentation of headache in pituitary tumor.
Recent prospective evaluations indicate that risk factors for development of headache in the setting of pituitary adenoma include highly proliferative tumors, cavernous sinus invasion, and personal or family history of headache. Migraine-like headaches are the predominant presentation. Unilateral headaches are often ipsilateral to the side of cavernous sinus invasion. In summary, this paper describes how the size and type of pituitary tumors play an important role in causation of headaches. Pituitary adenoma-associated headache can also mimic primary headache disorders making recognition of a secondary process difficult. Therefore, this paper highlights the association of between trigeminal autonomic cephalgias and pituitary adenomas and urges practitioners to maintain a high index of suspicion when evaluating patients with these uncommon headache presentations. However, on balance, given the prevalence of both primary headache disorders and pituitary adenomas, determining causality can be challenging. A thoughtful and multidisciplinary approach is often the best management strategy, and treatment may require the expertise of multiple specialties including neurology, neurosurgery, and endocrinology.
本文概述了垂体腺瘤患者头痛的相关情况。本文旨在向医疗服务提供者介绍垂体瘤头痛的关联、可能的病理生理学机制和临床表现，以提高对该疾病的认识。
近期前瞻性评估表明，垂体腺瘤患者头痛的发生风险因素包括：肿瘤高度增殖、海绵窦侵袭以及头痛的个人或家族史。偏头痛样头痛是主要表现形式。单侧头痛常与海绵窦侵袭的同侧相对应。综上所述，本文描述了垂体瘤的大小和类型如何在头痛的发生中起重要作用。垂体腺瘤相关头痛也可能模拟原发性头痛障碍，使对继发性疾病的识别变得困难。因此，本文强调了三叉自主神经性头痛与垂体腺瘤之间的关联，并敦促临床医生在评估这些不常见头痛表现的患者时保持高度怀疑。然而，鉴于原发性头痛障碍和垂体腺瘤的普遍存在，确定因果关系可能具有挑战性。全面且多学科的方法通常是最佳的管理策略，治疗可能需要神经科、神经外科和内分泌科等多个专业的专业知识。
