Postoperative headache in acoustic neuroma

Recently, it has become obvious that disabling postoperative headache is a major problem with acoustic neuroma surgery. A questionnaire was used to retrospectively evaluate the incidence, clinical features, prognosis and possible therapeutic measures of this particular form of headache. Forty-two percent (42%) of patients had some headache prior to surgery but this was not a major complaint. After surgery, 75% of patients experienced headache. Only 24% had complete relief of headache. A very gradual improvement of the pain occurred in 32%. Pathogenesis remains unclear, but clinical characteristics of the headache suggest a combination of tension-type, neuralgic and vascular components. Postoperative pain occurs mostly around the surgical site suggesting that this type of headache is the result of surgical trauma. A prospective long-term study is needed to delineate this condition further. Some therapeutic suggestions are offered.