1. Headache in Patients with Sellar Disease: Clinicomorphological Predictors of Headache and the Outcome of Endoscopic Transsphenoidal Surgery.
- Author
-
Joseph M, Alvarado R, Jonker BP, Winder MJ, Earls P, Campbell R, Kalish LH, Sacks R, Davidson AS, McCormack A, and Harvey RJ
- Abstract
Objectives Sellar pathologies are frequently found on imaging performed to investigate headache. However, both headache and incidental sellar lesions are common. Hence, this study prospectively examined headache prevalence, phenotype, and severity in patients with sellar pathologies and the impact of transsphenoidal surgery on headache. Methods Patients undergoing transsphenoidal resection of sellar lesions were consecutively recruited. At baseline, participants were defined as having headache or not and headache phenotype was characterized using validated questionnaires. Headache severity was assessed at baseline and 6 months postoperatively using the Headache Impact Test-6 (HIT-6) and Migraine Disability Assessment Score (MIDAS). Tumor characteristics were defined using radiological, histological, and endocrine factors. Primary outcomes included baseline headache prevalence and severity and headache severity change at 6 months postoperatively. Correlation between headache and radiological, histological, and endocrine characteristics was also of interest. Results Sixty participants (62% female, 47.1 ± 18.6 years) were recruited. Sixty-three percent possessed baseline headache. HIT-6 scores were higher in patients with primary headache risk factors, including younger age (R
2 = -0.417, p = 0.010), smoking history (63.31 ± 7.93 vs 54.44 ± 9.21, p = 0.0060), and family headache history (68.13 ± 7.01 vs 54.94 ± 9.11, p = 0.0030). Headaches were more common in patients with dural invasion (55.70 ± 12.14 vs 47.18 ± 10.15, p = 0.027) and sphenoid sinus invasion (58.87 ± 8.97 vs 51.29 ± 10.97, p = 0.007). Postoperative severity scores improved more with higher baseline headache severity (HIT-6: R2 = -0.682, p < 0.001, MIDAS: R2 = -0.880, p < 0.0010) and dural invasion (MIDAS: -53.00 ± 18.68 vs 12.00 ± 17.54, p = 0.0030). Conclusion Headaches in sellar disease are likely primary disorders triggered or exacerbated by sellar pathology. These may respond to surgery, particularly in patients with severe headache and dural invasion., Competing Interests: Conflict of Interest R. J. H. is consultant with Medtronic, Stryker, Novartis, Meda, and NeilMed pharmaceuticals. Research grant funding received from Glaxo-Smith-Kline and Stallergenes. He has been on the speakers' bureau for Glaxo-Smith-Kline, Meda Pharmaceuticals, and Seqirus. A. M. has received speaker fees and research grants from Novartis Pharmaceuticals, Ipsen, and Pfizer. B. P. J. has received speaker fees from Integra LifeSciences Corporation. L. H. K. is on the speakers' bureau for Care Pharmaceuticals and Mylan Pharmaceuticals. R. S. is a consultant for Medtronic and is in the speaker bureau for Meda Pharmaceuticals. All other authors have no financial disclosures or conflicts of interest., (Thieme. All rights reserved.)- Published
- 2023
- Full Text
- View/download PDF