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Headaches after AN surgery

While AN's themselves seldom cause particularly disturbing headaches, troublesome headaches (and neck aches) after surgery is an all-too-common problem. 

I am now post op 7 months...I am still out of work, due to a side effect of the surgery ~ cluster headaches, neck and shoulder pain, and now muscle spasms in both shoulders.

Many of ANA's questionnaires have focused on the issue of headaches. From the ANA publication "Headache following Acoustic Neuroma Surgery", come the following quotes:

A survey of 280 ANA members in 1989 revealed that while 42.5% had headache before surgery, over 75% had it following their operation.

In a survey of 541 patients enrolled in the ANA, 34% identified headache as a significant residual problem following their operation.  In a series of 273 patients from Denmark, headache was identified as a persistent problem in 29%.

Many possible ways of dealing with headaches have been identified, but there is no guaranteed cure.  When they persist, post-surgery headaches can significantly affect the AN patients' quality of life but tend to be ignored by the medical community:

It's the one year Anniversary of my son's AN surgery, when he just turned 12...  There were so many things that we were not told to us... like the severe headaches and spasms that the doctors can't understand why a now 13 year old boy cannot get control of. The lack of UNDERSTANDING angers me beyond words... Do the doctors fully comprehend how one's life is drastically changed? Isn't it their obligation to be there to get you through the next year to years of recovery instead of making you feel that your pain is not real?.. Will his life ever be normal? Will he ever be able to do the things he once did? Will he ever be able to attend school full time again?...  Doctors do not want to prescribe pain medications because he has become addicted to them, and that in itself causes rebound headaches... When isurance doesn't cover hypnosis, massage therapy, bio-feedback, counseling... where is one to turn?.. These headaches are not like anything you have ever experienced and very few doctors are totally understanding to your pain... My son's case is considered to be a success. He only suffers from the so called "headache" and "spasms". Don't be lead to believe that these are not LIFE changing or that you can just get on with your life. It would be nice if it were just that simple.

There is an excellent article on post-surgical headaches is at the UCSF web site.  The article is from "NEUROTOLOGY" by R. K. Jackler. The second paragraph is of interest:

An inverse relationship between tumor size and the incidence of headaches was noted. The patient group at highest risk of suffering persistent postoperative headaches was those with small tumors (< 1 cm diameter) operated via a retrosigmoid approach for hearing conservation purposes.

A diagnosis of "occipital neuralgia" is often made for these patients.  According to Dr. N. Vijayan, an AN post-operative headache specialist, the occipital nerve can become entrapped in scar tissue during the post-surgical healing, thus causing the pain.

At other times, the headache is caused by a change of pressure inside the skull as a result of the surgical intereference.  To minimize this change, the areas need to be packed with fat or muscle, and the hole made in the skull should be covered up, in a procedure known as cranioplasty. 

Often, the bone is filed during cranioplasty for a good fit - but watch out for bone dust, or it can cause more headaches it prevents!  Below is an abstract from American Journal of Otology (Nov'96, 17(6), pp. 904-908), article titled "Prevention of headache after retrosigmoid removal of acoustic tumors," by P. Catalano, O. Jacobowitz and K. Post:

PATIENTS: Eighty-four consecutive patients underwent surgery at the Mount Sinai Medical Center in New York by the same surgical team. 
INTERVENTION: All patients underwent retrosigmoid removal of ANs via the following methods: group 1, standard excision; group 2, excision and cranioplasty; group 3, excision, cranioplasty, and residue trapping.
RESULTS: In all, 43 patients (51%) reported postoperative headache. By groups, headache incidence was 64% for group 1 (43% grade 3-4), 81% for group 2 (37% grade 3-4), and 10% (all grade 1) for group 3. Differences with respect to headache incidence and severity were statically significant between groups 1 and 3, and between groups 2 and 3 (p < 0.001).
CONCLUSIONS: Free circulation of bone dust into the posterior fossa during intradural drilling of the internal auditory canal may be the most important factor in the development of headache after this surgical procedure.

It seems that the way to avoid bone dust circulation is by preparing the area surrounding the AN with a gelfoam of some sort.

Nowadays, improved surgical techniques have lowered the post-surgical headache rate. However, improved detection techniques (MRIs) have increased the diagnosis rate for those without significant symptoms. So the unfortunate fact remains that surgery increases the incidence of headaches, which often do not start till several months after surgery.  Here are some particularly severe patient stories.

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Last Edited: Wednesday, October 30, 2002