Scar neuromas as triggers for headache after craniotomy: clinical evidence

Abstract

We present four cases of headache with variable intensity, located in close proximity to a craniotomy incision which was performed for non-traumatic reasons. Since manual palpation of the scar often triggers pain, and infiltration with local anesthetics reduce or abolish the pain in some patients, we suggest that neuromas or nerve entrapment in the scars, as a result of the surgery, are responsible for headaches. Although local infiltrations or nerve blocks are often used for diagnostic reasons, herein we consider that they are also of therapeutic value. We review the current known pathophysiology of post-craniotomy headaches and present a hypothesis suggesting a greater recognition of the potential contribution of neuroma formation in areas of scars tissue to contribute to this kind of headache.

Nerve Block for the Treatment of Headaches and Cranial Neuralgias – A Practical Approach

“…The headache may resolve spontaneously or persist for years. The presence of neuromas and the compression/stretching of the nerves surrounding the scar are possible pathophysiological mechanisms that may explain this condition …”

“…Our experience shows that infiltration of the surgical scar is an important adjunctive therapy in the management of this type of headache. Frequently, patients report absence or significant improvement of pain for months to years after local infiltration …”

“…). In our service, these procedures have been applied for years in the treatment of headaches related to neurosurgical scars with no major side effects …”

“…Nerve block consists of transitory cessation of nerve impulse conduction, usually for the purpose of pain relief. This minimally invasive procedure has been used in many headache and neuralgic disorders for diagnosis and/or therapeutic purposes . In general, the peripheral nerve block is well accepted and tolerated, and is not often associated with serious adverse effects …”

Headache Research and Medical Practice in Brazil: An Historical Overview

“…We will mention a few other Brazilians and the IHS member under whose supervision they studied or worked with: Luiz Paulo Queiroz/Alan M. Rapoport; Fernando Kowacs/Peter Goadsby; Mario Peres/Stephen Silberstein. Marcelo Eduardo Bigal started his training in headache medicine under the supervision of José Geraldo Speciali and Carlos Bordini, finalizing both MSc and PhD theses at Ribeirao Preto School of Medicine‐USP, and receiving postdoctoral training with Richard B. Lipton in New York.…”