Photo Credit: Adobe

The following is a summary of “Natural Progression of Pineal Cysts in Relation to Headache: A Prospective Observational Study,” published in the March 2025 issue of European Journal of Neurology by Hvingelby et al. 

Pineal cysts are common incidental findings in imaging, but their link to headaches remains controversial. 

Researchers conducted a prospective study to track the clinical and radiological progression of pineal cysts in patients with and without headaches. 

They studied patients with pineal cysts ≥5 mm referred to Karolinska Hospital from June 2005 to April 2017, stratified by headache status and classified by standard criteria. Cyst size, aqueduct stenosis, and headache progression were tracked. 

The results showed 157 cysts (50 males, 107 females, mean age 37 years), with 103 in patients assessed for headaches. Cyst size remained stable, with no link to headache presence, progression, or treatment response. No association was found between quadrigeminal plate mass effect and headache. Of 13 patients treated with melatonin, 7 (53%) reported reduced headache severity. 

Investigators found most incidental pineal cysts during headache evaluations. Cyst size and symptoms remained stable over time, with therapeutic implications yet to be explored. 

Source: onlinelibrary.wiley.com/doi/full/10.1111/ene.70120