Causes of persistent postoperative headache after surgery for vestibular schwannoma

Our aim was to elucidate the actiology of persistent postoperative headache , a common sequel for several years after vestibular schwannoma surgery thr ough the retrosigmoid approach. Twenty-seven patients with reported major p ostoperative headache were tested for vestibular responses and cervico-coll ic reflexes, The role of local anaesthesia injected into the neck muscle in sertions or around the occipital nerves was evaluated. Sixteen patients ope rated on for vestibular schwannoma, but without headache, and 12 healthy vo lunteers 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 resu lts, The posturography results were increased among both patient groups. Su matriptan alleviated pain in nine patients and abolished it completely in o ne out of these nine patients. Vestibular imbalance or abnormal activation of neck muscles do not explain postoperative headache. Occipital nerve entr apment or neuralgia explains the headache in a few patients. The relatively pronounced sumatriptan effect may, however, suggest a trigeminal nerve med iated cause for postoperative headache.