Headache and Pituitary Disease
Headache and Pituitary Disease
The International Classification of Headache Disorders-II (ICHD-II) of the International Headache Society (IHS) is the most frequently used system for the classification of headaches. It differentiates between primary headaches (such as TTH, MIG, cluster headache and other trigeminal neuralgias), secondary headaches and cranial neuralgias, facial pain and other headaches and contains numerous subgroups. The aetiology of many primary headache syndromes is not conclusively elucidated. Pathophysiological explanations include genetic, neurobiological and psychosocial mechanisms. When headache occurs de novo in temporal relation with another disorder thought to be capable of causing it, such as traumatic brain injury, acute cerebrovascular disease or a brain tumour, it is classified as secondary, even if the headache phenomenology corresponds to MIG, THH or cluster headache. An example of a secondary headache related to pituitary disease is 'headache attributed to pituitary apoplexy'. The third large group of headaches according to the ICHD-II consists of pain syndromes mediated by afferent fibres (e.g. trigeminal, glossopharyngeal and vagus nerves and the nervus intermedius) as well as headache syndromes not fitting any of the other existing categories.
A clear differentiation between primary and secondary headaches is not always possible. Thus, the ICHD-II introduced a new way of diagnosing and coding primary headaches which worsen significantly in close temporal relation to another disorder known to cause headache. Many patients with an association of pituitary disease and headache fit to this classification (for an overview see ). TAC, a rare subgroup of headache disorders presenting with lateralized pain accompanied by cranial autonomic features, constitute another example of headaches associated with pituitary disease (for an overview see ) and can be classified as primary or secondary headache or both. Cluster headache, paroxysmal hemicrania, SUNCT/SUNA and hemicrania continua belong into this category. As the key feature of TACs is the lateralization of symptoms and signs, it has been suggested that an underlying pituitary region pathology is considered and that appropriate imaging diagnostics are initiated. Table 1 summarizes this classification of headaches and lists the current pharmacological therapeutic approaches when an underlying disease is not classified.
International Headache Classification and Its Relevance for Pituitary Disease
The International Classification of Headache Disorders-II (ICHD-II) of the International Headache Society (IHS) is the most frequently used system for the classification of headaches. It differentiates between primary headaches (such as TTH, MIG, cluster headache and other trigeminal neuralgias), secondary headaches and cranial neuralgias, facial pain and other headaches and contains numerous subgroups. The aetiology of many primary headache syndromes is not conclusively elucidated. Pathophysiological explanations include genetic, neurobiological and psychosocial mechanisms. When headache occurs de novo in temporal relation with another disorder thought to be capable of causing it, such as traumatic brain injury, acute cerebrovascular disease or a brain tumour, it is classified as secondary, even if the headache phenomenology corresponds to MIG, THH or cluster headache. An example of a secondary headache related to pituitary disease is 'headache attributed to pituitary apoplexy'. The third large group of headaches according to the ICHD-II consists of pain syndromes mediated by afferent fibres (e.g. trigeminal, glossopharyngeal and vagus nerves and the nervus intermedius) as well as headache syndromes not fitting any of the other existing categories.
A clear differentiation between primary and secondary headaches is not always possible. Thus, the ICHD-II introduced a new way of diagnosing and coding primary headaches which worsen significantly in close temporal relation to another disorder known to cause headache. Many patients with an association of pituitary disease and headache fit to this classification (for an overview see ). TAC, a rare subgroup of headache disorders presenting with lateralized pain accompanied by cranial autonomic features, constitute another example of headaches associated with pituitary disease (for an overview see ) and can be classified as primary or secondary headache or both. Cluster headache, paroxysmal hemicrania, SUNCT/SUNA and hemicrania continua belong into this category. As the key feature of TACs is the lateralization of symptoms and signs, it has been suggested that an underlying pituitary region pathology is considered and that appropriate imaging diagnostics are initiated. Table 1 summarizes this classification of headaches and lists the current pharmacological therapeutic approaches when an underlying disease is not classified.
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