Abstract
Dear Sir I read with extreme interest the paper from Schankin et al. (1). This study shows that 32% of patients had headache for > 6 months after surgery for acoustic neuroma. The literature on post-craniotomy is based mainly on retrospective studies about that kind of surgery and, as far as I know, this is the first prospective study about headache related to infra-tentorial surgery.
These authors found that the occurrence of post-surgical headache was significantly correlated with preoperative headache and the number of perioperative complications. Preoperative headache as a risk factor for post-craniotomy headache is controversial in the literature (2,3). The patients in this study had a surprisingly low prevalence of primary headaches before surgery (2.7% of episodic tension-type headache and 1.8% of migraine). It is important to know how this prevalence was determined (headache in life? headache in the last year?).
The most prevalent pattern of post-surgical headache was tension-type-like headache (46.7%). Recently, we did a prospective study in supratentorial post-craniotomy headache and observed a decrease in the prevalence of migrainous-type-like headache during the follow-up period (4). It is possible that the predominance of tension-type-like headache found by Schankin et al. is related to the moment of evaluation (1 year after surgery). Other retrospectives studies that found this predominance had accessed the headache months or years after the surgery (5–7).
It is a pity that the authors considered only headaches with a severity of at least 6/10 on the nominal analogue scale (NAS) that persists for > 6 months after surgery. The prevalence of post-craniotomy headache lessens with the time after surgery (2,4–6), and probably the incidence of headache was higher than what was found. It would be of great interest if Schankin et al. could write another paper with their data that verify the incidence of post-craniotomy headache according to the International Headache Society (IHS) criteria and the characteristics of all headaches that these patients had.