Headache in patients with Sellar disease: Clinicomorphological Predictors of Headache and the Outcome of Endoscopic Transsphenoidal Surgery

Maria Joseph*, Raquel Alvarado, Benjamen P. Jonker, Mark Winder, Peter Earls, Raewyn G. Campbell, Larry Kalish, Raymond Sacks, Andrew S. Davidson, Ann McCormack, Richard J. Harvey

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objectives  Sellar pathologies are frequently found on imaging performed to investigate headache. However, both headache and incidental sellar lesions are common. Hence, this study prospectively examined headache prevalence, phenotype, and severity in patients with sellar pathologies and the impact of transsphenoidal surgery on headache. Methods  Patients undergoing transsphenoidal resection of sellar lesions were consecutively recruited. At baseline, participants were defined as having headache or not and headache phenotype was characterized using validated questionnaires. Headache severity was assessed at baseline and 6 months postoperatively using the Headache Impact Test-6 (HIT-6) and Migraine Disability Assessment Score (MIDAS). Tumor characteristics were defined using radiological, histological, and endocrine factors. Primary outcomes included baseline headache prevalence and severity and headache severity change at 6 months postoperatively. Correlation between headache and radiological, histological, and endocrine characteristics was also of interest. Results  Sixty participants (62% female, 47.1 ± 18.6 years) were recruited. Sixty-three percent possessed baseline headache. HIT-6 scores were higher in patients with primary headache risk factors, including younger age (R 2  = -0.417, p  = 0.010), smoking history (63.31 ± 7.93 vs 54.44 ± 9.21, p  = 0.0060), and family headache history (68.13 ± 7.01 vs 54.94 ± 9.11, p  = 0.0030). Headaches were more common in patients with dural invasion (55.70 ± 12.14 vs 47.18 ± 10.15, p  = 0.027) and sphenoid sinus invasion (58.87 ± 8.97 vs 51.29 ± 10.97, p  = 0.007). Postoperative severity scores improved more with higher baseline headache severity (HIT-6: R 2  = -0.682, p  < 0.001, MIDAS: R 2  = -0.880, p  < 0.0010) and dural invasion (MIDAS: -53.00 ± 18.68 vs 12.00 ± 17.54, p  = 0.0030). Conclusion  Headaches in sellar disease are likely primary disorders triggered or exacerbated by sellar pathology. These may respond to surgery, particularly in patients with severe headache and dural invasion.

Original languageEnglish
Pages (from-to)247-254
Number of pages8
JournalJournal of Neurological Surgery, Part B: Skull Base
Issue number3
Early online dateMar 2023
Publication statusE-pub ahead of print - Mar 2023


  • dural invasion
  • endoscopic transphenoidal surgery
  • pituitary tumours
  • primary headache
  • secondary headache
  • sellar tumours


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