Headache syndromes after acoustic neuroma surgery and their implications for quality of life

Abstract

The patients of this prospective study were analysed for headache as a sequela of surgery for acoustic neuroma (AN). Thirty-two per cent (30/95) of patients complained about a persisting headache syndrome with a severity of at least 6/10 on the nominal analogue scale 6 months after surgery. The occurrence of headache was significantly correlated with the prospectively evaluated parameters preoperative headache and the number of perioperative complications. Postoperative failure to return to the preoperative level of activity was also associated with the occurrence of headache, but also with the risk of retirement after successful surgery of the AN. Headache is therefore, like postoperative ataxia, dysgeusia and probably facial paresis, an important factor for the overall outcome of patients after AN surgery. Hypacusis is not as important. The symptoms and course of each individual patient were analysed. The attempt to categorize the headaches according to the second edition of the International Classification of Headache Disorders revealed five headache syndromes, the most prevalent being tension-type-like headache (46.7%), followed by neuralgia of the occipital nerve (16.6%), trigeminal neuropathy (16.6%), neuropathy of the intermedian nerve (10.0%) and cervicogenic headache (10.0%). The respective pathophysiological mechanisms are discussed and treatment options based on the clinical picture are presented.