Background Headache is very frequent following endoscopic endonasal surgery (EES) for pituitary adenomas, and affects the quality of life of patients, but was seldomly concerned before. This study aims to investigate the effect of nasal irrigation on relieving headache after EES. Methods A cohort of 101 pituitary adenoma patients (Cohort I) undergone EES were retrospectively analyzed to explore the risk factors of postoperative headache. Another cohort of 72 patients (Cohort II) accepted adjuvant nasal irrigation following surgery, were enrolled for further analysis. The Headache Impact Test (HIT-6) was used to score the headache, and patients with a HIT score of > 55 was considered with headache. Results In cohort I, 21.78% of patients suffered headache 1-month after EES, but decreased to 5.94% 3-month postoperatively. Multivariate analysis showed that postoperative sinusitis (OR = 3.88, 95%CI 1.16–13.03, p = 0.028) and Hardy's grade C-D (OR = 10.53, 95%CI 1.02-109.19, p = 0.049) independently predicted the presence of postoperative headache at 1 month. At the follow up of 3 months, the HIT-6 score was higher in the patients with sinusitis than the one without sinusitis (44.43 ± 9.78 vs. 39.72 ± 5.25, p = 0.017). In Cohort II, the incidence of sinusitis at 3 months was significantly lower than that in Cohort I (p = 0.028). More importantly, both headache incidence and HIT-6 score of the patients in Cohort II were significantly lower than those in Cohort I, at the follow up at 1- and 3- month. Conclusions Postoperative sinusitis is an independent risk factor for the presence of headache following EES for pituitary adenomas. And prophylactic nasal irrigation helps to relieve postoperative headache, probably by preventing the presence of sinusitis.

Purpose Headache is common among patients with pituitary adenomas undergone endoscopic endonasal surgery (EES), but was seldomly concerned before. The present study aims to investigate the incidence and profile of risk factors of headache after EES.Methods A meta-analysis was performed to evaluate the occurrence proportions of postoperative headache in patients with pituitary adenomas. Then, a cohort of 101 patients undergone EES were enrolled for analyzing risk factors of headache. The Headache Impact Test (HIT-6) was used to score the headache preoperatively, 1 month and 3 months postoperatively. Results A total of 18 studies and 4442 participants were included for meta-analysis. The pooled occurrence proportion of postoperative headache was 29% (95% confidential interval: 20-38%). For the 101 patients enrolled in the present study, 26 (25.74%) of them had a HIT-6 scores of > 55 preoperatively, but decreased to 22 (21.78%) at 1 month, and 6 (5.94%) at 3 months, postoperatively. Multivariate analysis showed that pituitary apoplexy (OR=3.591, 95%CI 1.219-10.575, p=0.020) and Hardy's grade C-D (OR=21.06, 95%CI 2.25-197.02, p=0.008) were independently risk factors for preoperative headache. In contrast, postoperative sinusitis (OR=3.88, 95%CI 1.16-13.03, P=0.028) and Hardy's grade C-D (OR=10.53, 95%CI 1.02-109.19, P=0.049) independently predicted the presence of postoperative headache at 1 month. At 3 months postoperatively, the proportion of sinusitis tended to be higher in the headache group than the one in non-headache group (100% vs. 30.0%, p=0.070). Conclusion Headache is very common following EES for pituitary adenomas. Prophylactic management of postoperative sinusitis may help to alleviate postoperative headache.