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 heada che 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 tra nslabyrinthine resection of acoustic neuroma complained of headache fo llowing surgery. The average pain intensity was greater for the subocc ipital approach. Only 9 percent(n = 14) reported troublesome or freque nt headaches preoperatively. Headache was described most often as tens ion type, with episodic acute exacerbations mimicking migraine. Clinic al observations suggest that most patients are treated successfully wi th various combinations of reassurance, tricyclic antidepressants, non steroidal anti-inflammatory medications, trigger-point injections, adj unctive stress management techniques (relaxation), and physical therap y. The impact of recurrent headache on work and recreational function is notable. Several possible pathophysiological and biopsychosocial mo dels are proposed to account for the prevalent headache problem. Altho ugh spontaneous resolution usually occurs over time, additional study is needed to determine the natural history of postoperative headache o nce it occurs.