De novo or continuation of Intractable Headache with Autonomic Features even after Treatment of Hypophyseal Macroadenoma: Case Series Report

Headache is a known complication of the pituitary lesion. Different treatment methods such as surgery and radio-surgery used to treat these tumors, there are some reports of patients in whom preoperative headaches still exist after surgery or de novo postoperative headache started.Here we report 4 cases of headaches under vented transsphenoidal surgery of pituitary lesions. These patients had been referred to the Headache Clinic of Sina Hospital, Tehran, Iran since 2012. Headaches were strictly unilateral, mostly in the left periorbital area, and were accompanied by ipsilateral autonomic features. As these types of headaches were so similar, and no CSF leak, abscess, pneumocephalus, cerebral infection or hemorrhage, meningitis, and hydrocephalus were found for them and they were resistant to different treatment modalities, we considered them to report for more attention.