Giuliani Giada, Costa Denise, Pellicano Chiara, Gargiulo Patrizia, Virili Camilla, Di Piero Vittorio, Altieri Marta
Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.
Department of Experimental Medicine, Endocrinology-Pituitary Disease, Sapienza University of Rome, Rome, Italy.
Headache. 2025 May;65(5):826-834. doi: 10.1111/head.14927. Epub 2025 Mar 13.
To investigate the characteristics and nature of headache in a population of patients with acromegaly.
Headache is frequently described by patients with pituitary adenomas. Although it is mainly considered a secondary disorder, it can persist despite effective therapy for pituitary disease. A proper description of headache according to the subtype of pituitary adenoma is not available in literature. In this light, we aimed to analyze headache characteristics in a population of patients with acromegaly.
In this registry-based retrospective cohort study, headache features were collected through a structured telephone interview. The clinical picture of each patient was classified according to the third edition of the International Classification of Headache Disorders criteria. We carefully investigated the time course and the relationship of headache with acromegaly.
Out of 39 enrolled patients, 27 (69%) reported headache. Six patients (15%) fulfilled secondary headache criteria, with complete headache resolution after acromegaly treatment. In all, 21 patients (54%) met the criteria for a primary headache: fourteen had episodic migraine, four had chronic migraine, and three had tension-type headache. No trigeminal autonomic cephalalgias were observed. The presence of primary headache significantly reduced the time to diagnosis of acromegaly (mean [standard deviation] 2.1 [2.5] vs. 4.3 [3.5] years, p = 0.007). The occurrence of primary headache was similar in patients with macroadenoma compared to patients with microadenoma (14 [67%] vs. 7 [33%], χ = 0.591, p = 0.400), while its course was not significantly influenced either by the acromegaly treatment (p = 0.670) or the achievement of biochemical control (p = 0.490).
Secondary headache was found only in a small percentage of our patients. Most of them had a primary headache with a high prevalence of migraine, suggesting that acromegaly might act as a trigger for this disorder. Considering the potentially disabling nature, primary headaches in patients with acromegaly require careful evaluation and personalized management.
研究肢端肥大症患者群体中头痛的特征及性质。
垂体腺瘤患者常描述有头痛症状。尽管其主要被视为继发性疾病，但即便垂体疾病得到有效治疗，头痛仍可能持续存在。目前文献中尚无根据垂体腺瘤亚型对头痛进行恰当描述的内容。鉴于此，我们旨在分析肢端肥大症患者群体中的头痛特征。
在这项基于登记处的回顾性队列研究中，通过结构化电话访谈收集头痛特征。根据《国际头痛疾病分类》第三版标准对每位患者的临床表现进行分类。我们仔细研究了头痛的时间进程以及与肢端肥大症的关系。
在39名登记患者中，27名（69%）报告有头痛症状。6名患者（15%）符合继发性头痛标准，肢端肥大症治疗后头痛完全缓解。总计21名患者（54%）符合原发性头痛标准：14名患有发作性偏头痛，4名患有慢性偏头痛，3名患有紧张型头痛。未观察到三叉自主神经性头痛。原发性头痛的存在显著缩短了肢端肥大症的诊断时间（平均[标准差]2.1[2.5]年 vs. 4.3[3.5]年，p = 0.007）。与微腺瘤患者相比，大腺瘤患者原发性头痛的发生率相似（14名[67%] vs. 7名[33%]，χ = 0.591，p = 0.400），而其病程不受肢端肥大症治疗（p = 0.670）或生化指标控制情况（p = 0.490）的显著影响。
我们的患者中仅一小部分存在继发性头痛。他们中的大多数患有原发性头痛，偏头痛患病率较高，这表明肢端肥大症可能是这种疾病的触发因素。考虑到原发性头痛可能具有致残性，肢端肥大症患者的原发性头痛需要仔细评估和个性化管理。
