Question: How long is it “normal” to have a headache following pituitary surgery? Also, if a headache persists longer than that, what should the patient do?

Answer: Post operative headache of a persistent nature is rare after trans-sphenoidal surgery. The most common cause for early headache in the first 2 weeks after surgery is due to nasal stuffiness or sinus obstruction. Diagnosis of that can be easily made with a plain x-ray. Treatment is generally by use of standard cold medications. Another possibility within the first 2 weeks is the development of a low serum sodium (hyponatremia) due to water retention. Diagnosis is made by a blood test to measure serum sodium. Treatment is generally fluid restriction or additional salt; this generally lasts for several days and permanently resolves. Prolonged headache beyond 2 weeks post operatively raises a question of a possible CSF leak that results in air entering the skull. This is once again easily seen on a plain skull x-ray. The possibility of a chronic sinusitis must also be entertained; a sinus series on x-ray or CT scan should be diagnostic. If a fever is present, one has to be suspicious of meningitis. In unusual cases of giant tumors, a patient might develop post-operative hydrocephalus that can be diagnosed by CT scan and might require a shunting procedure to resolve. Finally, in cases of growth hormone secreting tumors (Acromegaly), one may have persistent headaches if the GH is still elevated and the skull continues to expand. Other than these, one would treat such symptoms symptomatically, perhaps by a pain specialist.

By Dr. Martin Weiss MD (Spring, 2009)