Causes of persistent postoperative headache after surgery for vestibular schwannoma

Our aim was to elucidate the aetiology of persistent postoperative headache, a common sequel for several years after vestibular schwannoma surgery through the retrosigmoid approach. Twenty-seven patients with reported major postoperative headache were tested for vestibular responses and cervico-collic reflexes. The role of local anaesthesia injected into the neck muscle insertions or around the occipital nerves was evaluated. Sixteen patients operated on for vestibular schwannoma, but without headache, and 12 healthy volunteers served as control groups. Vestibular responses and cervico-collic reflexes deteriorated equally in the patients regardless of whether or not they had a postoperative headache. Local anaesthesia did not alter the results. The posturography results were increased among both patient groups. Sumatriptan alleviated pain in nine patients and abolished it completely in one out of these nine patients. Vestibular imbalance or abnormal activation of neck muscles do not explain postoperative headache. Occipital nerve entrapment or neuralgia explains the headache in a few patients. The relatively pronounced sumatriptan effect may, however, suggest a trigeminal nerve mediated cause for postoperative headache.