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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2020; 78(01): 28-33
DOI: 10.1590/0004-282X20190143
Article

Resolution of headache after reduction of prolactin levels in hyperprolactinemic patients

Resolução de cefaleia após redução dos níveis de prolactina em pacientes com hiperprolactinemia
Miriam da Costa OLIVEIRA 
1   Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-Graduação em Patologia, Porto Alegre RS, Brazil.
2   Irmandade Santa Casa de Misericórdia de Porto Alegre, Centro de Neuroendocrinologia, Porto Alegre RS, Brazil.
,
Liselotte Menke BAREA 
3   Universidade Federal de Ciências da Saúde de Porto Alegre, Departamento de Neurologia, Porto Alegre RS, Brazil.
,
Andreia Peres Klein HORN 
2   Irmandade Santa Casa de Misericórdia de Porto Alegre, Centro de Neuroendocrinologia, Porto Alegre RS, Brazil.
,
Bárbara Roberta ONGARATTI 
1   Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-Graduação em Patologia, Porto Alegre RS, Brazil.
,
José Otávio Dworzeki SOARES 
3   Universidade Federal de Ciências da Saúde de Porto Alegre, Departamento de Neurologia, Porto Alegre RS, Brazil.
,
Bruna ARAUJO 
2   Irmandade Santa Casa de Misericórdia de Porto Alegre, Centro de Neuroendocrinologia, Porto Alegre RS, Brazil.
,
Tainá Mafalda dos SANTOS 
2   Irmandade Santa Casa de Misericórdia de Porto Alegre, Centro de Neuroendocrinologia, Porto Alegre RS, Brazil.
,
Carolina Leães RECH 
2   Irmandade Santa Casa de Misericórdia de Porto Alegre, Centro de Neuroendocrinologia, Porto Alegre RS, Brazil.
,
Júlia Fernanda Semmelmann PEREIRA-LIMA 
1   Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-Graduação em Patologia, Porto Alegre RS, Brazil.
2   Irmandade Santa Casa de Misericórdia de Porto Alegre, Centro de Neuroendocrinologia, Porto Alegre RS, Brazil.
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Abstract

Prolactin (PRL) secreting adenomas are associated with high incidence of headache. The role of hyperprolactinemia in the headache context is not clear, nor is the effect of its treatment on headache. Methods: The present longitudinal study evaluated hyperprolactinemic patients (69), in terms of presence and characteristics of headache before and after hyperprolactinemia treatment. Results: Headache was reported by 45 (65.2%) patients, independent of the etiology of hyperprolactinemia. The migraine phenotype was the most prevalent (66.6%). Medications used in the treatment of headache not changed during the study. The first line of treatment of hyperprolactinemia was dopaminergic agonists. In the last reevaluation, PRL level under treatment was within the reference range in 54.7% of the cases, and it was observed complete or partial resolution of the headache in 75% of the cases. The median PRL at this time in patients with complete headache resolution was 17 ng/mL, in those who reported partial recovery was 21 ng/mL, and in those in whom the headache did not change was 66 ng/mL, with a significant difference between the group with complete headache resolution vs. the group with unchanged headache (p=0.022). In the cases with complete headache resolution, the median fall on PRL levels was 89% and in those cases with partial headache resolution 86%, both significantly different (p<0.001) from the fall in the cases with an unchanged headache. Conclusion: Data allow us to conclude that, in this series, in the majority of cases the reduction in the level of PRL was followe3d by cessation or relief of the pain.

Resumo

Os adenomas secretores de prolactina (PRL) estão associados à alta incidência de cefaleia. O papel da hiperprolactinemia no contexto da dor de cabeça não está claro, nem o efeito da redução dos níveis da PRL na cefaleia. Métodos: O presente estudo longitudinal avaliou pacientes hiperprolactinêmicos (69), quanto à presença e às características da cefaleia antes e após o tratamento da hiperprolactinemia. Resultados: Cefaleia foi relatada por 45 (65,2%) pacientes, independente da etiologia da hiperprolactinemia. O fenótipo de enxaqueca foi mais prevalente (66,6%). Os medicamentos usados no tratamento da cefaleia não foram alterados durante o estudo. A primeira linha de tratamento da hiperprolactinemia foram os agonistas dopaminérgicos. Na última reavaliação, o nível de PRL sob tratamento estava dentro da faixa de referência em 54,7% dos casos, observando-se resolução completa ou parcial da cefaleia em 75% dos casos. A mediana de PRL neste momento em pacientes com resolução completa da cefaleia foi de 17 ng/mL, nos que relataram recuperação parcial foi de 21 ng/mL, e naqueles em que a cefaleia não se alterou foi de 66 ng/mL, com uma diferença significativa entre o grupo com resolução completa da cefaleia versus o grupo com cefaleia inalterada (p=0,022). Nos casos com resolução completa da cefaleia, a queda mediana nos níveis de PRL foi de 89% e nos casos com resolução parcial de cefaleia de 86%, ambos significativamente diferentes (p<0,001) da queda nos casos com cefaleia inalterada. Conclusão: Os dados permitem concluir que, nesta série, na maioria dos casos, a redução do nível de PRL foi seguida pela cessação ou alívio da dor.

Keywords:

headache - pituitary adenomas - prolactin - hyperprolactinemia - dopaminergic agonist

Palavras-chave:

cefaleia - adenomas hipofisários - prolactina - hiperprolactinemia - agonista dopaminérgico


Publication History

Received: 26 August 2019

Accepted: 12 September 2019

Article published online:
13 June 2023

© 2019. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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