Determinants and impact of headache after acoustic neuroma surgery.

Headache after acoustic neuroma surgery is known to occur clinically, but has not been studied systematically until recently. In the present study, 155 patients were surveyed regarding their experience of headache and associated symptoms following resection of an acoustic neuroma: 73 percent (n = 98) of patients undergoing suboccipital resection of an acoustic neuroma and 53 percent (n = 8) of patients undergoing translabyrinthine resection of acoustic neuroma complained of headache following surgery. The average pain intensity was greater for the suboccipital approach. Only 9 percent (n = 14) reported troublesome or frequent headaches preoperatively. Headache was described most often as tension type, with episodic acute exacerbations mimicking migraine. Clinical observations suggest that most patients are treated successfully with various combinations of reassurance, tricyclic antidepressants, nonsteroidal anti-inflammatory medications, trigger-point injections, adjunctive stress management techniques (relaxation), and physical therapy. The impact of recurrent headache on work and recreational function is notable. Several possible pathophysiological and biopsychosocial models are proposed to account for the prevalent headache problem. Although spontaneous resolution usually occurs over time, additional study is needed to determine the natural history of postoperative headache once it occurs.