Understanding Pituitary Tumor Headaches : Symptoms, Evaluation, and Treatment

A pituitary tumor is the development of an abnormal growth in the pituitary gland. It arises from the cells in the pituitary gland itself and from nearby tissues that affect the pituitary gland. These are classified on the basis of size and hormone-producing behavior. Most of the pituitary tumors are benign, which means they are not cancerous.⁽¹⁾ 

Functioning pituitary tumors produce excessive amounts of one or more hormones which leads to hormonal imbalance. The non-functioning tumors do not produce hormones.

Pituitary tumors can lead to a variety of symptoms including headaches. The headaches associated with pituitary tumors can vary in frequency, intensity, and characteristics. A study done in 2021 stated that it’s unclear if a tumor is directly responsible for pain, but headaches are generally common.⁽²⁾

The tumors particularly the larger ones can compress the optic nerves or optic chiasm. The compression can lead to visual disturbances including blurred vision, double vision, loss of peripheral vision, and even complete loss of vision. There is also fatigue and weakness, cognitive and emotional changes, and other symptoms including nasal congestion, frequent urination, loss of libido, unexplained weight gain, dry skin, and brittle nails.

It is important to understand pituitary tumor headaches for the following reasons:

• Early Diagnosis and Treatment: Pituitary tumors particularly the non-functioning tumors can be asymptomatic or can be present with nonspecific symptoms. Having an understanding of signs and symptoms associated with pituitary tumors can be helpful in early diagnosis and allows prompt treatment. This reduces the risk of complications.
• Hormonal Balance Restoration: Pituitary tumors can disrupt the normal production and regulation of hormones. Managing pituitary tumors at the earliest can be helpful in restoring the hormonal balance that is crucial for maintaining overall health and well-being.
• Improves Quality of Life: By knowing about the symptoms and tailoring the treatment approaches, healthcare professionals can optimize symptom relief and enhance the quality of life.
• Research and Advancement: Understanding and managing pituitary tumors can be helpful in contributing to ongoing research and advancement in the field.

Pituitary tumor headache is a common symptom experienced by people with pituitary tumors. Also, not all pituitary tumors cause symptoms, if symptoms occur they are similar for all individuals.⁽³⁾ There are various factors that can lead to headaches due to the presence of a tumor and its effect on the surrounding structures.

• Increased Intracranial Pressure: Increase in the size of pituitary tumors can increase intracranial pressure. This may compress the nearby structures, including blood vessels, nerves, and brain tissue.
• Compression of Pain-Sensitive Structures: Enlargement of tumors can lead to compression of pain-sensitive structures such as meninges or nerve fibers, which can lead to headaches and discomfort.
• Disturbance of Pain Pathways: Large pituitary tumors can disrupt the normal function of pain pathways in the brain, which may affect the transmission and processing of pain signals leading to the development of headaches.
• Hormonal Imbalance: Pituitary tumors may over or underproduce certain hormones. This disruption in hormones can lead to headaches in some people.
• Inflammation and Vascular Changes: Pituitary tumors may trigger inflammation in the surrounding tissues. This may irritate the nerves or blood vessels and cause headaches.
• Tumor Location: The location of the pituitary tumors within the bony cavity where the pituitary gland is located can influence the characteristics of associated headaches.

Pituitary tumor headaches are centered around the front of the head, particularly into the forehead and around the eyes.⁽⁴⁾ The headache characteristic is a dull ache or pressure. The intensity of the headache may vary from mild to severe. The type of headache may be debilitating and may affect daily activities. The headache may last for several hours or days and may be constant.

The triggers such as stress, physical exertion, staining, or sudden movements may worsen the headaches. The headache may improve or worsen with changes in posture such as bending forward or lying down.

The symptoms associated with pituitary headaches include nausea, vomiting, dizziness, or hormonal imbalance.

The characteristics and patterns may vary among people and not everyone with a pituitary tumor may experience the same symptom.

Larger pituitary tumors have a higher likelihood of increasing headache severity. The tumors exert higher pressure on the surrounding structures including the protective covering of the brain, blood vessels, and nerves. The large tumors can also compress the nearby structures including the optic nerves and optic chiasm. This may lead to additional symptoms.

Pituitary tumors may invade the surrounding structures such as the cavernous sinus or nearby brain tissue. This may increase the headache severity. Also, if the tumor is located close to the pain-sensitive structures, it can trigger a more intense headache.

Evaluation starts with the healthcare professional taking the complete medical history including the headache symptoms, their frequency, duration, and associated features.

The doctor may also enquire about other symptoms experienced. Other factors that are considered for evaluation of pituitary tumor headache are as follows:

• A physical examination is performed with a focus on assessing the neurological function, visual fields, and signs of hormonal imbalance. The head, neck, and other relevant areas are examined to identify any physical signs related to pituitary tumors.
• The healthcare professional may also perform a neurological assessment to evaluate the cranial nerves, reflexes, strength, sensation, and coordination. This helps in identifying any associated neurological deficits or abnormalities.
• Blood tests are ordered for hormonal evaluation. This is to check the hormonal imbalance caused by pituitary growth. The blood test looks for prolactin, growth hormone, adrenocorticotropic hormone, and thyroid-stimulating hormone.

Some specialized tests are done to assess the pituitary function or evaluate specific hormone-secreting tumors. These may include dynamic hormone testing including oral glucose tolerance tests or hormone stimulation tests.

Treatment for pituitary tumor headache involves addressing the tumor and headache symptoms. The treatment depends on the size of the tumor, its location, and hormone-secreting activity. It also depends on individual activity.

Common treatment options include:

• Medication Management: Medications include non-steroidal anti-inflammatory drugs for mild to moderate headaches. Triptan medications used for migraine are given for severe headaches. Beta-blockers, tricyclic antidepressants, or antiepileptic medications such as beta blockers are given to reduce the frequency and intensity of headaches.
• Hormonal Management: Medications including dopamine agonists such as bromocriptine or cabergoline are prescribed to lower prolactin levels and shrink tumors. Somatostatin analogs are used to reduce growth hormone levels and control symptoms including headaches. Surgery medications or radiation therapy may be given to manage hormonal imbalances and associated symptoms.
• Surgical Interventions: Transsphenoidal surgery is the primary surgical approach for pituitary tumors. In this, the tumor is removed by nasal passage. A craniotomy is done for larger and more invasive tumors.
• Radiation Therapy: If it’s not possible to remove the tumor completely by surgery, radiation therapy can be an option. It controls tumor growth and reduces the symptoms including headaches.

Regular monitoring and follow-up visits with healthcare professionals specializing in endocrinology and neurology are essential to ensure the tumor is under control.

Pituitary tumor headache occurs in and around the forehead and behind the eyes. The location and type of pain depend on the size of the tumor and its location. Individualized care and treatment plans based on the specific character of the pituitary tumor and the patient’s needs are essential for optimal outcomes. It is important to consult a healthcare professional specializing in endocrinology and neurology for the long-term management of pituitary tumor headaches.