Bob Johnson
CH.com Alumnus
 
Offline

"Only the educated are free." -Epictetus
Posts: 5965
Kennett Square, PA (USA)
Gender:
|
The evidence is far from clear so far. Here are two fairly recent reports which you might like to print out for your doc. ======== cephalalgia. 2007 feb;27(2):173-6.
typical cluster headache caused by granulomatous pituitary involvement.
favier i, haan j, van duinen s, ferrari m.
department of neurology, leiden university medical centre, leiden, the netherlands.
a young woman had typical cluster headache attacks and a pituitary mass lesion. the headache attacks resolved after transsphenoidal resection of the tumour, which was diagnosed as a granulomatous inflammation. the association between cluster headache and granulomatous enlargement of the pituitary gland has never been described before. THIS CASE REINFORCES THE GROWING EVIDENCE THAT EVEN IN TYPICAL CASES OF CLUSTER HEADACHE, NEUROIMAGING IS MANDATORY TO EXCLUDE STRUCTURAL LESIONS.
pmid: 17257239 [pubmed - in process] ====================
(You may need your doc to interpret this one!)
Cephalalgia. 2008 Sep 2. [Epub ahead of print] What happens to new-onset headache presented to primary care? A case-cohort study using electronic primary care records.
Kernick D, Stapley S, Goadsby P, Hamilton W.
St Thomas Medical Group, Exeter, UK.
In the UK, 4% of general practitioner consultations are for headache, yet the natural history of these presentations is unknown. The objective of this study was to describe the outcome of new headache presentations to the general practitioner. This was a prospective case-control study in adults over a period of 1 year using data from the General Practitioner Research Database, UK. RECORDS OF PATIENTS WHO PRESENTED WITH PRIMARY HEADACHE (MIGRAINE, TENSION-TYPE HEADACHE, CLUSTER HEADACHE) OR UNDIFFERENTIATED HEADACHE (NO FURTHER DESCRIPTOR) WERE EXAMINED FOR THE SUBSEQUENT YEAR FOR SUBARACHNOID HAEMORRHAGE, PRIMARY BRAIN TUMOUR, BENIGN SPACE-OCCUPYING LESION, TEMPORAL ARTERITIS, STROKE AND TRANSIENT ISCHAEMIC ATTACK. WE IDENTIFIED 21 758 PRIMARY HEADACHES AND 63 921 UNDIFFERENTIATED HEADACHES. THE LIKELIHOOD RATIO WAS 29 (9.9, 92) FOR A SUBARACHNOID HAEMORRHAGE AFTER AN UNDIFFERENTIATED HEADACHE AND INCREASED WITH AGE. THE 1-YEAR RISK OF A MALIGNANT BRAIN TUMOUR WITH NEW UNDIFFERENTIATED HEADACHE WAS 0.15%, RISING TO 0.28% ABOVE THE AGE OF 50 YEARS. FOR PRIMARY HEADACHE THE RISK WAS 0.045%. THE RISK FOR A BENIGN SPACE-OCCUPYING LESION WAS 0.05% FOR AN UNDIFFERENTIATED AND 0.009% FOR A PRIMARY HEADACHE. THE RISK OF TEMPORAL ARTERITIS WAS THE HIGHEST OF THE CONDITIONS STUDIED, 0.66% IN THE UNDIFFERENTIATED AND 0.18% IN THE PRIMARY HEADACHE GROUP. Accepting the limitations of this approach, our data can inform management guidelines for new presentations of headache in primary care and confirm the need for follow-up, even if a primary headache diagnosis is made.
PMID: 18771496 [PubMed]
|