title: Chronic daily headaches secondary to greater auricular and lesser occipital neuromas following endolymphatic shunt surgery.
abstract: In head and neck surgery, peripheral sensory nerves are at risk for traumatic injury. These injuries are known to be peripheral triggers of chronic headaches if left untreated or unrecognised. We report the case of a patient that presented with a severe headache, nausea and emesis of 2 years duration following endolymphatic shunt placement for Meniere's disease. Nerve blockade suggested a peripheral trigger, and surgical exploration of the incision site revealed traumatic neuromas of the greater auricular and lesser occipital nerves. Subsequent nerve resection yielded complete symptomatic relief. This is the first case report of a peripherally triggered migraine headache due to the development of neuromas of the greater auricular and lesser occipital nerves, also representing a previously unreported complication of endolymphatic shunt placement. It is recommended that in patients presenting with intractable migraines and a history of head and neck surgery, diagnostic nerve blockage be used to assess for neuromas.
authors.affiliation: Saint Louis University School of Medicine, Saint Louis, MO, USA.
authors.forename: Leon
authors.initials: L
authors.lastname: Vorobeichik
authors.forename: Michael A
authors.initials: MA
authors.lastname: Fallucco
authors.forename: Robert R
authors.initials: RR
authors.lastname: Hagan
mesh_terms: D003391:Cranial Nerves / Q000473:pathology* / Q000601:surgery; D004713:Endolymphatic Shunt / Q000009:adverse effects*; D005260:Female; D020773:Headache Disorders / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008575:Meniere Disease / Q000150:complications / Q000601:surgery*; D008875:Middle Aged; D008881:Migraine Disorders / Q000209:etiology* / Q000601:surgery; D009325:Nausea / Q000209:etiology; D009407:Nerve Block; D009463:Neuroma / Q000150:complications* / Q000601:surgery; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D014839:Vomiting / Q000209:etiology