Headaches Associated with Rathke's Cleft Cyst


  • Hiroshi Nishioka MD, PhD,

  • Jo Haraoka MD, PhD,

  • Hitoshi Izawa MD, PhD,

  • Yukio Ikeda MD, PhD

  • From the Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan (Nishioka, Haraoka); Department of Neurosurgery, Hachioji Medical Center, Tokyo Medical University, Tokyo, Japan (Nishioka, Izawa, Ikeda)

Address all correspondence to Dr. Hiroshi Nishioka, Department of Neurosurgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.


Objective.—Headaches are common presentations in patients with Rathke's cleft cyst (RCC). This study was conducted to elucidate the characteristics and underlying mechanisms of the headache.

Methods.—We retrospectively studied 46 patients with RCC, 33 of whom underwent surgical intervention.

Results.—Headache, particularly frontal headache, was the most common symptom, occurring in 27 patients (58.7%). Eleven patients with sudden episodic headache mimicking that of pituitary apoplexy. Although the presence of headache did not correlate with cyst size, it was significantly more common in RCCs with: high- and iso intensity content on T1-weighted MR image (P= .0363), mucous content within the cyst (P= .0023), and intense chronic inflammation at the cyst wall (P= .0276). Among 6 patients with histologically recognized intense inflammation, every patient had frontal headache (P= .0407), 5 patients had episodic headache (P= .0002), and 4 patients had associated hypopituitarism (P= .0073), none of which improved after surgical intervention. Headaches improved after surgery in 17 of 21 patients (81.0%).

Conclusions.—Headache, particularly frontal episodic headache, is a common and characteristic manifestation in patients with RCC and may indicate intermittent inflammatory reactions caused by mucous content. Patients with episodic headache should undergo surgical treatment to prevent exacerbation of the inflammation that can result in irreversible endocrine dysfunction.