A study of acromegaly-associated headache with somatostatin analgesia

Sonia Kaniuka-Jakubowska (Lead / Corresponding author), Miles J. Levy, Aparna Pal, Dayakshi Abeyaratne, William M. Drake, Nikolaos Kyriakakis, Robert D. Murray, Steve M. Orme, Shailesh Gohil, Antonia Brooke, Graham P. Leese, Márta Korbonits, John AH Wass

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    7 Citations (Scopus)
    226 Downloads (Pure)

    Abstract

    The aim of this study is to characterise somatostatin analogue-responsive headache in acromegaly, hitherto not systematically documented in a significant cohort. Using the UK pituitary network, we have clinically characterised a cohort of 18 patients suffering from acromegaly-related headache with a clear response to somatostatin analogues. The majority of patients had chronic migraine (78%) as defined by the International Headache Society diagnostic criteria. Headache was present at the time of acromegaly presentation and clearly associated temporally with disease activity in all cases. Short-acting somatostatin analogues uniquely resolved pain within minutes and the mean duration of analgesia was 1-6 h. Patients on long-acting analogues required less short-acting injections (mean: 3.7 vs 10.4 injections per day, P = 0.005). 94% used somatostatin analogues to control ongoing headache pain. All patients presented with macroadenoma, most had incomplete resection (94%) and headache was ipsilateral to remnant tissue (94%). Although biochemical control was achieved in 78% of patients, headache remained in 71% of them. Patients selected for this study had ongoing headache post-treatment (mean duration: 16 years after diagnosis); only four patients reached headache remission 26 years (mean range: 14-33) after the diagnosis. Headache in acromegaly patients can be persistent, severe, unrelieved by surgery, long-lasting and uncoupled from biochemical control. We show here that long-acting analogues allow a decrease in the number of short-acting analogue injections for headache relief. Further studies are needed to understand the mechanisms, markers and tumour tissue characteristics of acromegaly-related headache. Until then, this publication serves to provide the clinical characteristics as a reference point for further study.

    Original languageEnglish
    Article numbere220138
    JournalEndocrine-Related Cancer
    Volume30
    Issue number3
    Early online date16 Feb 2023
    DOIs
    Publication statusPublished - Mar 2023

    Keywords

    • acromegaly-related headache
    • headache in acromegaly
    • pituitary tumour-associated headache
    • somatostatin responsive headache

    ASJC Scopus subject areas

    • Endocrinology, Diabetes and Metabolism
    • Oncology
    • Endocrinology
    • Cancer Research

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