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.
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We thank Mr. Tyler Clay for English correction.
Compliance with ethical standards
Conflict of interest
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.
Aoki KR, Francis J (2011) Updates on the antiociceptive mechanism hypothesis of botulinum toxin A. Parkinsonism Relat Disord 17(Suppl 1):S28–S33CrossRefPubMedGoogle Scholar
Choi D, Raisman G (2004) After facial nerve damage, regenerating axons become aberrant throughout the length of the nerve and not only at the site of the lesion: an experimental study. Br J Neurosurg 18:45–48CrossRefPubMedGoogle Scholar
Headache Classification Committee of the International Headache Society (2013) The International Classification of headache disorders, 3rd edition (beta version). Cephalagia 33:629–808CrossRefGoogle Scholar
Kadri PA, Al-Mefty O (2004) The anatomical basis for surgical preservation of temporal muscle. J Neurosurg 100:517–522CrossRefPubMedGoogle Scholar
Rocha-Filho PA, Fujarra FJ, Gherpelli JL, Rabello GD, de Siqueira JT (2007) The long-term effect of craniotomy on temporalis muscle function. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 104:17–21CrossRefGoogle Scholar
Rocha-Filho P, Gherpelli J, de Siqueira J, Rabello GD (2010) Post-craniotomy headache: a proposed revision of IHS diagnostic criteria. Cephalalgia 30:560–566CrossRefPubMedGoogle Scholar
Rocha-Filho PA (2015) Post-craniotomy headache: a clinical view with a focus on the persistent form. Headache 55(5):733–738CrossRefPubMedGoogle Scholar
Schaller B, Baumann A (2003) Headache after removal of vestibular schwannoma via the retrosigmoid approach: a long-term follow-up-study. Otolaryngol Head Neck Surg 128:387–395CrossRefPubMedGoogle Scholar
Yaşargil MG, Reichman MV, Kubik S (1987) Preservation of the frontotemporal branch of the facial nerve using the interfascial temporalis flap for pterional craniotomy. J Neurosurg 67:463–466CrossRefPubMedGoogle Scholar