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Chronic cluster headache and the pituitary gland.
- Source :
-
The journal of headache and pain [J Headache Pain] 2016; Vol. 17, pp. 23. Date of Electronic Publication: 2016 Mar 11. - Publication Year :
- 2016
-
Abstract
- Background: Cluster headache is classified as a primary headache by definition not caused by an underlying pathology. However, symptomatic cases of otherwise typical cluster headache have been reported.<br />Case Presentation: A 47-year-old male suffered from primary chronic cluster headache (CCH, ICHD-3 beta criteria fulfilled) since the age of 35 years. A magnetic resonance imaging (MRI) study of the brain in 2006 came back normal. He tried several prophylactic treatments but was never longer than 1 month without attacks. He was under chronic treatment with verapamil with only a limited effect on the attack frequency. Subcutaneous sumatriptan 6 mg injections were very effective in aborting attacks. By February 2014 the patient developed a continuous interictal pain ipsilateral to the right-sided cluster headache attacks. An indomethacin test (up to 225 mg/day orally) was negative. Because of the change in headache pattern we performed a new brain MRI, which showed a cystic structure in the pituitary gland. The differential diagnosis was between a Rathke cleft cyst and a cystic adenoma. Pituitary function tests showed an elevated serum prolactin level. A dopamine agonist (cabergoline) was started and the headache subsided completely. Potential pathophysiological mechanisms of pituitary tumor-associated headache are discussed.<br />Conclusion: Neuroimaging should be considered in all patients with CCH, especially those with an atypical presentation or evolution. Response to acute treatment does not exclude a secondary form of cluster headache. There may be shared pathophysiological mechanisms of primary and secondary cluster headache.
- Subjects :
- Adenoma drug therapy
Adenoma pathology
Cabergoline
Central Nervous System Cysts drug therapy
Central Nervous System Cysts pathology
Cluster Headache drug therapy
Cluster Headache pathology
Diagnosis, Differential
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Pituitary Neoplasms drug therapy
Pituitary Neoplasms pathology
Sumatriptan therapeutic use
Treatment Outcome
Verapamil therapeutic use
Adenoma complications
Central Nervous System Cysts complications
Cluster Headache etiology
Dopamine Agonists therapeutic use
Ergolines therapeutic use
Pituitary Gland pathology
Pituitary Neoplasms complications
Subjects
Details
- Language :
- English
- ISSN :
- 1129-2377
- Volume :
- 17
- Database :
- MEDLINE
- Journal :
- The journal of headache and pain
- Publication Type :
- Academic Journal
- Accession number :
- 26969187
- Full Text :
- https://doi.org/10.1186/s10194-016-0614-0