title: Risk factors and analysis of long-term headache in sporadic vestibular schwannoma: a multicenter cross-sectional study.
abstract: OBJECTIVE
  The primary goals of this study were: 1) to examine the influence of disease and treatment on headache in patients with sporadic vestibular schwannoma (VS); and 2) to identify clinical predictors of long-term headache disability.
  
  
  METHODS
  This was a cross-sectional observational study with international multicenter enrollment. Patients included those with primary sporadic <3-cm VS and a separate group of general population control subjects without tumors. Interventions included a postal survey incorporating the Headache Disability Inventory (HDI), the Hospital Anxiety and Depression Scale, and a VS symptom questionnaire. The main outcome measures were univariate and multivariable associations with HDI total score.
  
  
  RESULTS
  The overall survey response rate was 79%. Data from 538 patients with VS were analyzed. The mean age at time of survey was 64 years, 56% of patients were female, and the average duration between treatment and survey was 7.7 years. Twenty-seven percent of patients received microsurgery, 46% stereotactic radiosurgery, and 28% observation. Patients with VS who were managed with observation were more than twice as likely to have severe headache disability compared with 103 control subjects without VS. When accounting for baseline differences, there was no statistically significant difference in HDI outcome between treatment modalities at time of survey. Similarly, among the microsurgery cohort, the long-term risk of severe headache disability was not different between surgical approaches. Multivariable regression demonstrated that younger age, greater anxiety and depression, and a preexisting diagnosis of headache were the primary predictors of severe long-term headache disability, while tumor size and treatment modality had little influence.
  
  
  CONCLUSIONS
  At a mean of almost 8 years following treatment, approximately half of patients with VS experience headaches of varying frequency and severity. Patient-driven factors including age, sex, mental health, and preexisting headache syndrome are the strongest predictors of long-term severe headache disability. Tumor size and treatment modality have less impact. These data may assist with patient counseling regarding long-term expectations following diagnosis and treatment.
authors.affiliation: Departments of 1 Otolaryngology-Head and Neck Surgery.|Neurologic Surgery, and.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Carlson
authors.affiliation: Neurosurgery, Haukeland University Hospital; and.
authors.forename: Øystein Vesterli
authors.initials: ØV
authors.lastname: Tveiten
authors.affiliation: Departments of 1 Otolaryngology-Head and Neck Surgery.|Neurologic Surgery, and.
authors.forename: Colin L
authors.initials: CL
authors.lastname: Driscoll
authors.affiliation: Neurology, Mayo Clinic School of Medicine, Rochester, Minnesota; 
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Boes
authors.affiliation: Departments of 1 Otolaryngology-Head and Neck Surgery.
authors.forename: Molly J
authors.initials: MJ
authors.lastname: Sullan
authors.affiliation: Departments of 4 Otolaryngology and.
authors.forename: Frederik K
authors.initials: FK
authors.lastname: Goplen
authors.affiliation: Neurosurgery, Haukeland University Hospital; and.|Institute of Surgical Sciences, University of Bergen, Norway.
authors.forename: Morten
authors.initials: M
authors.lastname: Lund-Johansen
authors.affiliation: Departments of 1 Otolaryngology-Head and Neck Surgery.|Neurologic Surgery, and.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Link
mesh_terms: D000368:Aged; D001007:Anxiety / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D006261:Headache / Q000209:etiology*; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000150:complications* / Q000473:pathology / Q000601:surgery; D019635:Neurosurgical Procedures; D011379:Prognosis; D016634:Radiosurgery; D012307:Risk Factors; D016896:Treatment Outcome; D057832:Watchful Waiting
keywords: CPA = cerebellopontine angle; Gamma Knife radiosurgery; HADS = Hospital Anxiety and Depression Scale; HDI = Henry Ford Hospital Headache Disability Inventory; HRQOL = health-related quality of life; ICHD-II = International Classification of Headache Disorders, Second Edition; IQR = interquartile range; PANQOL = Penn Acoustic Neuroma Quality of Life; SRS = stereotactic radiosurgery; VS = vestibular schwannoma; acoustic neuroma; cephalgia; cerebellopontine angle; headache; microsurgery; oncology; pain; stereotactic radiosurgery; vestibular schwannoma