Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jun;41(7):779-788.
doi: 10.1177/0333102420983303. Epub 2021 Jan 6.

Is pituitary MRI screening necessary in cluster headache?

Lou Grangeon  1   2 , Emer O'Connor  1 , Daisuke Danno  1 , Thanh Mai Pham Ngoc  3 , Sanjay Cheema  1 , Erling Tronvik  3   4   5 , Indran Davagnanam  6 , Manjit Matharu  1
Affiliations

Is pituitary MRI screening necessary in cluster headache?

Lou Grangeon et al. Cephalalgia. 2021 Jun.

Abstract

Objective: To determine the prevalence and clinical predictors of pituitary adenomas in cluster headache patients, in order to determine the necessity of performing dedicated pituitary magnetic resonance imaging in patients with cluster headache.

Methods: A retrospective study was conducted of all consecutive patients diagnosed with cluster headache and with available brain magnetic resonance imaging between 2007 and 2017 in a tertiary headache center. Data including demographics, attack characteristics, response to treatments, results of neuroimaging, and routine pituitary function tests were recorded.

Results: Seven hundred and eighteen cluster headache patients attended the headache clinic; 643 underwent a standard magnetic resonance imaging scan, of whom 376 also underwent dedicated pituitary magnetic resonance imaging. Pituitary adenomas occurred in 17 of 376 patients (4.52%). Non-functioning microadenomas (n = 14) were the most common abnormality reported. Two patients, one of whom lacked the symptoms of pituitary disease, required treatment for their pituitary lesion. No clinical predictors of those adenomas were identified after multivariate analysis using random forests. Systematic pituitary magnetic resonance imaging scanning did not benefit even a single patient in the entire cohort.

Conclusion: The prevalence of pituitary adenomas in cluster headache is similar to that reported in the general population, thereby precluding an over-representation of pituitary lesions in cluster headache. We conclude that the diagnostic assessment of cluster headache patients should not include specific pituitary screening. Only patients with standard brain magnetic resonance imaging findings or symptoms suggestive of a pituitary disorder require brain magnetic resonance imaging with dedicated pituitary views.

Keywords: Cluster headache; neuroimaging; pituitary MRI; pituitary lesion; trigeminal autonomic cephalalgias.

PubMed Disclaimer

Conflict of interest statement

Declaration of conflicting interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: LG, EO, DD, TP, SC, ET and ID report no disclosures. MSM serves on the advisory board for Abbott, Allergan, Eli Lilly, Medtronic, Novartis and TEVA and has received payment for the development of educational presentations from Allergan, electroCore, Eli Lilly, Novartis and TEVA.

Figures

Figure 1.
Figure 1.
Flow diagram showing patient disposition throughout the trial.
Figure 2.
Figure 2.
Coronal (a) and sagittal (b) sections of the MRI scan of a cluster headache patient with a macroprolactinoma.
See this image and copyright information in PMC

References

    1. Headache Classification Subcommittee of The International Headache Society . The International Classification of Headache Disorders 3rd edition (beta version). Cephalalgia 2013; 33: 629–808. - PubMed
    1. Lambru G, Matharu MS. Trigeminal autonomic cephalalgias: A review of recent diagnostic, therapeutic and pathophysiological developments. Ann Ind Acad Neurol 2012; 15: S51–S61. - PMC - PubMed
    1. Russell MB. Epidemiology and genetics of cluster headache. Lancet Neurol 2004; 3: 279–283. - PubMed
    1. Favier I, van Vliet JA, Roon KI, et al.. Trigeminal autonomic cephalgias due to structural lesions: A review of 31 cases. Arch Neurol 2007; 64: 25–31. - PubMed
    1. de Coo IF, Wilbrink LA, Haan J. Symptomatic trigeminal autonomic cephalalgias. Curr Pain Headache Rep 2015; 19: 39. - PMC - PubMed

MeSH terms

LinkOut - more resources