headaches

[legalsec07]

I was diagnosed with a 6 x 7mm pituitary tumor; however, my doctor isn't sure if this has been causing my constant migraines for the past 2 years.  When would I know it is time to have surgery?  It is non-functioning but pressing on the pituitary causing low cortisol levels.

[Sara Khan]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.

Have you had migraines all your life?? Are these headaches different from the headaches you have had in the past? A pituitary tumor, and for that matter any lesion in the brain can cause headaches, or trigger migraines in someone who is prone to them. Although more in the realm of neurosurgery, the usual indications for resection of a non-functioning tumor would be worsening of headaches or any visual changes such as visual field cuts or complete vision loss. Usually they follow the size of the tumor with serial brain imaging, and decide on surgery on the basis of an increase in size, correlating with a change in symptoms. They also sometimes chose to operate based on the effect on hormones and if they stop responding to medications e.g in your case low cortisol levels. At the end of the day it will be discussion between you and your surgeon to decide if it is time to resect the tumor.

There are medications available which can be used on a daily basis to prevent headaches. These include antidepressants like Elavil, anti seizure medications like Topamax and Depakote to name a few. A neurologist would be able to prescribe the appropriate medications depending on the characteristics of your headache.

I hope this helps.

Good Luck!

[Sara Khan]

Another thing, a specific type of headache called SUNCT ( Short-lasting, Unilateral, Neuralgiform headache attacks with Conjunctival injection and Tearing ) has been associated with pituitary headaches in case reports, with resolution of the headaches with removal of the tumor. This is a rare form of headache that is most common in men after age 50. The disorder is marked by bursts of moderate to severe burning, stabbing, or throbbing pain, usually on one side of the head and around the eye or temple. Attacks typically occur in daytime hours and last from 5 seconds to 4 minutes per episode. Patients generally have five to six attacks per hour.  This is usually associated with tearing, redness of the eye, nasal congestion on the side of the headache.

I don't know what the specifics of your headache are, and if they fall in to the category of migraine. Usually for the above mention headaches, if all medications fail, then there should be discussion about attempting resection of the tumor in hopes to relieve the headaches.