INTRODUCTION: To what extent pituitary adenomas cause headache is controversial and the impact of transsphenoidal surgery on headache remains uncertain. METHODS: We conducted a prospective, single-centre study of patients undergoing surgery for pituitary adenomas between 2014 and 2024. Headache was assessed using the EORTC QLQ-BN20 module, question four, at baseline, one month, and six months postoperatively. Demographic, clinical, and surgical data were analysed for associations with headache outcomes. RESULTS: Of 207 eligible patients, 134 completed all assessments (63% male; median age 55 years). Preoperatively, 50% reported no headache, 33% a little, 8% quite a bit, and 9% very much headache. Headache was more common in females, but there was no relation to tumour related factors. At one month, 31% improved, 52% remained unchanged, and 16% worsened. At six months, 34% improved, 56% remained unchanged, and had 10% worsened compared to preoperatively. Among patients with preoperative headache (n = 67), 52% reported improvement at one month and 55% at six months. Among patients with no headache preoperatively, 25% and 12% reported having headache at one and six months, respectively. No demographic, tumour-related, or perioperative variables were significantly associated with headache change. CONCLUSION: In this prospective longitudinal study, approximately half of patients with preoperative headache reported improvement following pituitary surgery, while a minority experienced worsening. No clear clinical predictors of headache before surgery or outcome after surgery were identified, suggesting a multifactorial nature of headache in patients with pituitary adenomas.
Strand et al. (Mon,) studied this question.