Chronic Cluster-Like Headache Secondary to Prolactinoma: Uncommon Cephalalgia in Association with Brain Tumors

Abstract

Headache is a common and disabling aspect of pituitary disease. Chronic and episodic migraine are the most common clinical syndromes of headaches related to pituitary tumors, although other types of headache, such as trigeminal autonomic cephalalgias (TACs), can also be present. TACs include short-lasting, unilateral neuralgiform headache attacks with conjunctival injection and tearing; paroxysmal hemicrania; and cluster headache. We report on a patient with a chronic cluster-like headache associated with a macroprolactinoma. Although cabergoline, pregabalin, and corticosteroids were not effective as preventive treatments, high-dose verapamil showed good efficacy. Morphine and octreotide were efficacious as abortive treatments for attacks, but pain was only partially responsive to oxygen and refractory to subcutaneous sumatriptan.

Chronic cluster‐like headache in a patient with a macroprolactinoma presenting with falsely low prolactin levels: bromocriptine versus cabergoline?

“…Moreover, Negoro et al [5], Levy et al [6], and Andereggen et al [8] reported patients presenting with cluster-like headaches, which resolved immediately after starting cabergoline, indicating a strong possible relationship between levels of prolactin and cluster-like headaches. On the other hand, in two cases cabergoline did not improve this type of headache [3,4]. In one of these cases, cabergoline normalized prolactin but did not have any effect on headaches, suggesting that prolactin abnormal levels played no role in its pathogenesis [3].…”

“…Cluster-like headaches have been reported in association with pituitary tumors in at least 10 cases, mostly with prolactinomas [2][3][4][5][6][7][8]. Most of them presented as chronic cluster headaches.…”

Symptomatic Trigeminal Autonomic Cephalalgias

“…We found 23 cases with a cluster headache-like phenotype in 23 articles [ 2 , 5 , 6 •, 7 – 10 , 11 •, 12 – 26 ]. We excluded 3 patients, as they did not fulfil the ICHD-III criteria beta version, all having an attack duration of more than 3 h [ 18 , 23 , 25 ].…”

“…Another patient had an internal carotid artery dissection, but the outcome after treatment remained unclear [ 6 •]. Other diagnoses in this category are as follows: recurrent posterior scleritis and a specific meningitis (treated with prednisone), post-operative cluster headache (lens phacoemulsification and intraocular lens implant), an angiomyolipoma, and an ipsilateral macroprolactinoma [ 5 , 7 , 15 , 20 ]. The latter two patients responded completely or partly to treatment of the underlying lesion, but only in combination with preventive cluster headache treatment.…”

Trigeminal Autonomic Cephalgia Secondary to Cervical Myelopathy

“…The Neurohospitalist 12 (1) A 13-year-old boy was admitted with a 1 month history of attacks consisting of right retro-orbital pain associated with injection, tearing and photophobia confined to the affected side (Figure 1A). Each spell lasted for 5-10 minutes and he had many attacks per day.…”