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Keywords:

  • pituitary adenoma;
  • pituitary hemorrhage;
  • pituitary apoplexy;
  • migrainelike headache;
  • acute headache

A 23-year-old woman presented with a 4-day history of a severe migrainelike headache with a normal neurologica examination. The headache resolved after a ketorolac injection, but recurred a few hours later. An MRI scan of the brain showed a hemorrhagic pituitary macroadenoma for which she underwent transsphenoidal removal of the tumor 1 month later. Although uncommon, pituitary hemorrhage with and without apoplexy should be considered in the differential diagnosis of acute headache. Pituitary hemorrhage can be routinely identified on an MRI scan even without pituitary views. However, the pathology can be overlooked and underimaged on a CT scan for acute headache using 10-mm and even 5-mm slices.