From the Guidelines
Yes, pituitary adenomas can cause headaches, particularly when they grow large enough to press against surrounding structures, such as the optic nerves or the dura mater, as noted in the 2024 consensus guideline for the diagnosis and management of pituitary adenomas in childhood and adolescence 1.
Causes of Headaches in Pituitary Adenomas
The headaches associated with pituitary adenomas are typically described as frontal or behind the eyes and may be persistent or intermittent, with severity ranging from mild discomfort to severe pain. Larger tumors, known as macroadenomas (greater than 10mm), are more likely to cause headaches than smaller ones, called microadenomas (less than 10mm) 1.
Factors Influencing Headache Severity
The headaches may worsen when lying down or with activities that increase pressure in the head. It's essential to consider that pituitary adenomas can also affect hormone production and vision if left untreated, making prompt medical evaluation crucial, especially for individuals experiencing persistent headaches with visual changes 1.
Treatment Options
Treatment for pituitary adenomas depends on the size and type of the adenoma and may include:
- Medication to shrink the tumor, such as cabergoline or bromocriptine for prolactinomas
- Surgery to remove the tumor
- Radiation therapy Given the complexity and potential long-term impacts of pituitary adenomas, particularly in children and adolescents, a multidisciplinary approach to care, including systematic pituitary hormone assessment, expert neuroimaging, visual review, histopathology, informed genetic assessment, and evaluation by an expert pituitary surgeon, is recommended 1.
From the Research
Pituitary Adenomas and Headaches
- Pituitary adenomas are known to cause headaches in a significant number of patients, with studies suggesting that headache is present in more than a third of all patients with pituitary adenomas 2.
- The prevalence of headache among patients with pituitary adenoma (PA) is reported to be around 62% 3.
- The most common headache phenotypes in PA patients are migraine and tension-type headache, with trigeminal autonomic cephalalgias (TACs) observed only in prolactinoma patients 3.
Pathophysiology and Risk Factors
- The pathophysiology of headache in pituitary adenomas is not fully understood, but tumor size, cavernous sinus invasion, traction or displacement of intracranial pain-sensitive structures, and hormonal hypersecretion are implicated causes 2.
- 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 4.
- Hormonal hypersecretion, such as oversecretion of GH and prolactin, may also play a role in the development of headaches 2.
Treatment and Outcome
- Treatment of pituitary adenomas, including surgery and medical treatment, can lead to improvement or resolution of headaches in some patients 3, 2.
- However, the relationship between headaches and pituitary masses remains unclear, and intervention does not always improve headache and can lead to development of new headache syndromes 5.
- Headache alone is rarely an indication for surgical management of a pituitary adenoma 5.