Vestibular schwannoma surgery and headache

The aim of the study was to evaluate aetiological factors for postoperative headache after vestibular schwannoma (VS) surgery with respect to asymmetric activation of vestibular reflexes. After surgery, 27 VS patients with persistent postoperative headache, 16 VS patients without headache and 9 healthy controls were examined. The vestibular, cervicocollic and cervicospinal reflexes were evaluated to study whether asymmetric activation of vestibular reflexes could cause headache. The effect of neck muscle and occipital nerve anaesthesia and the effect of sumatriptan on headache were also evaluated. The vestibular function of VS patients with headache did not differ from that of VS patients without headache, but was abnormal when compared to that of normal controls. The cervicospinal and cervicocollic reflexes did not differ in the patient groups. Injection of lidocaine around the operation scar gave pain relief to two patients, and one of them had occipital nerve entrapment. Infiltration of lidocaine deep in the neck muscles in the vicinity of the C2 root did not alleviate headache, but caused vertigo. Nine patients with musculogenic headache got pain relief from supportive neck collars, and two patients with cervicobrachial syndrome got pain relief from manual neck traction. The study shows that asymmetric activation of cervicocollic reflexes does not seem to be the reason for headache. Headache seems to be linked to neuropathic pain, allegedly caused by trigeminal irritation of the inner ear and the posterior fossa, which has recently been linked to vascular pain.