A study of acromegaly-associated headache with somatostatin analgesia
Kaniuka-Jakubowska, Sonia Levy, Miles J. Pal, Aparna Abeyaratne, Dayakshi Drake, William M. Kyriakakis, Nikolaos Murray, Robert D. Orme, Steve M. Gohil, Shailesh Brooke, Antonia
Kaniuka-Jakubowska, Sonia
Levy, Miles J.
Pal, Aparna
Abeyaratne, Dayakshi
Drake, William M.
Kyriakakis, Nikolaos
Murray, Robert D.
Orme, Steve M.
Gohil, Shailesh
Brooke, Antonia
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.
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Kaniuka-Jakubowska, S., Levy, M. J., Pal, A., Abeyaratne, D., Drake, W. M., Kyriakakis, N., Murray, R. D., Orme, S. M., Gohil, S., Brooke, A., Leese, G. P., Korbonits, M., & Wass, J. A. (2023). A study of acromegaly-associated headache with somatostatin analgesia. Endocrine-related cancer, 30(3), e220138. https://doi.org/10.1530/ERC-22-0138