We report here the case of four patients presenting with delayed-onset temporal pain after pterional craniotomy. They reported similar symptoms: attacks of pain over the temporal region, ipsilateral to the operative site, irradiating around the eye and lasting from 10 min to 1 h. All patients had hypertrophy of at least one part of the temporalis muscle. All responded dramatically to botulinum toxin A injection (25 to 50 Botox® units) into the temporalis muscle. We suggest that the headaches were caused by aberrant nerve regeneration following surgical injury to the frontal branch of the facial nerve.
Dr. Ranoux is a consultant for Allergan and reports grants, personal fees and non-financial support from Allergan, outside the submitted work. The other co-authors have no conflict of interest to declare.
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
This study has been approved by the Ethics Committee of Limoges University Hospital.
Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.
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