Abstract
Objective Headache in patients with tumors of the sellar region (TSR) has
previously been attributed entirely to biomechanical causes. This study aimed to
investigate the influence of psychological determinants for the occurrence of
and disability due to headaches in patients with TSR.
Methods This was a cross-sectional single-center study with a logistic
regression approach. Eighty-four patients (75%) with pituitary adenomas
and 28 with other TSR prior to first-time neurosurgery were investigated.
One-hundred and twelve patients received standardized questionnaires on
personality, headache characteristics, and disability due to headache.
Fifty-nine patients additionally filled in questionnaires about coping with
stress and pain catastrophizing. Separate logistic regression models were used
to predict the risk of headache occurrence and disability due to headache by
personality, stress coping, and pain catastrophizing.
Results Conscientiousness, neuroticism, and pain catastrophizing were
significant predictors of headache occurrence. The amount of explained variance
for both models predicting headache occurrence was comparable to that in primary
headache. Neuroticism, pain catastrophizing, and humor as a coping strategy
predicted disability due to headache with a high variance explanation of
20–40%.
Conclusion For the first time, we report data supporting a strong
psychological influence on headache and headache-related disability in patients
with TSR, which argue against purely mechanistic explanatory models. Physicians
treating patients with TSR and headaches should adopt an integrative diagnostic
and treatment approach, taking the biopsychosocial model of pain into
account.
Key words
pain - pituitary adenoma - coping - personality - pain catastrophizing
