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Size Is Not Everything

Miles J. Levy; H. Rolf Jäger, MD; Michael Powell, FRCS; Manjit S. Matharu, MRCP; Karim Meeran, MD; Peter J. Goadsby, MD, PhD, DSc, FRACP, FRCP

Arch Neurol. 2004;61:721-725.

Background  Pituitary tumors are commonly associated with disabling headache. The accepted mechanisms for headache are dural stretch and cavernous sinus invasion.

Objective  To determine if there is a relationship between pituitary tumor size and the report of headache.

Design  We prospectively studied 63 patients who were initially seen with pituitary tumors. Clinical headache scores, pituitary tumor volume, and the extent of cavernous sinus invasion were obtained for each patient.

Results  The prevalence of headache was 70%. There was no positive correlation the between clinical headache score and pituitary volume (r = –0.32, P = .01, Spearman rank correlation). There was also no association between cavernous sinus invasion and headache. There was a strong association between pituitary-associated headache and a family history of headache (² = 8.36, P = .004).

Conclusions  These data suggest that a pituitary tumor–associated headache may not simply be a structural problem. Other factors such as family history of headache, and the endocrine activity of the tumor may be equally important determinants of headache. Elucidating these mechanisms will aid in the treatment of these patients and further our understanding of other headache syndromes.

From the Headache Group (Mr Levy and Drs Matharu and Goadsby) and the Department of Radiology (Dr Jäger), Institute of Neurology, Department of Neurosurgery, National Hospital for Neurology and Neurosurgery (Dr Powell), and the Department of Endocrinology, Hammersmith and Charing Cross Hospitals Trust (Dr Meeran), London, England.

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