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. 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.

Dr Maria Joseph graduated in 2019 from the University of New South Wales in Australia with a Doctor of Medicine with the University Medal. She went on to complete her first two years as a junior doctor in Sydney, followed by her early neurosurgical registrar years at The John Hunter Hospital in Newcastle. She is now a Royal Australian College of Surgeons SET Trainee in Neurosurgery, looking towards her fellowship in 2029. Maria’s interests include skull base surgery, particularly endoscopic endonasal approaches to anterior skull base tumours, and the investigation and improvement of neurosurgical outcomes in regional Australia. She has multiple publications, including in the Journal of Skull Base Surgery and Australia and New Zealand Journal of Surgery.