Abstract and Introduction
Abstract
Introduction Cluster headache belongs to a group of primary headache entities: the trigeminal autonomic cephalalgias. Cluster headache is the most common variant. The headache is usually severe and it is also associated with autonomic symptoms. Secondary causes of cluster headache have been reported, such as intracranial artery aneurysms and tumors. The question of when to carry out neuroimaging in patients with cluster headache is yet unsettled. To the best of the author's knowledge, cluster headache associated with a clinically non-functioning pituitary adenoma (chromophobe adenoma) has not been described. This case report describes the case of a man with cluster headache where the evaluation showed a clinically non-functioning pituitary adenoma.
Case presentation This case involved a 49-year-old Caucasian man who presented with a one-month history of side-locked attacks of pain located in the right orbit. His symptoms fulfilled the criteria for cluster headache and a diagnosis of cluster headache was made. The patient responded to symptomatic treatment. Enhanced magnetic resonance imaging showed a pituitary adenoma. Further evaluations including hormonal screening revealed a clinically non-functioning pituitary adenoma (chromophobe adenoma). After surgery to remove the tumor, his headache attacks resolved totally.
Conclusion Tumors have been reported in patients with cluster headache whose clinical attacks are identical to genuine cluster headache. A clinically non-functioning pituitary adenoma can present as cluster headache. This case emphasizes the need of imaging procedures in patients with cluster headache. Contrast-enhanced magnetic resonance imaging including the sella turcica should always be done in patients with cluster headache.
Introduction
Cluster headache (CH) belongs to a group of primary headache entities, the trigeminal autonomic cephalalgias. CH is the most common variant. Studies have demonstrated that CH has a lifetime prevalence of 0.12%. The headache is usually severe and is associated with autonomic symptoms. CH is more common in men and typically manifests itself between the third and fifth decades of life. The question of when to carry out neuroimaging in patients with CH is yet unsettled. Secondary causes of CH have been reported in many cases, such as intracranial artery aneurysms and tumors (symptomatic CH). The prevalence of symptomatic CHs is not identified because of a lack of prospective population-based studies. CH associated with pituitary adenoma has been described. To the best of the author's knowledge. CH associated with a clinically non-functioning pituitary adenoma (chromophobe adenoma) has not been described. This case report describes a man with typical CH in the setting of a clinically non-functioning pituitary adenoma.