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Had MVD craniotomy for Trigeminal Neuralgia. TN better. Why is there tenderness in scalp, pain while sneezing?

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I had MVD craniotomy for Trigeminal Neuralgia last October 2011. The TN is much better (I can actually chew real food now!) but I've had complications like: tenderness on right side of scalp (where Mayfield clamp was); pain and pressure when sneezing, coughing, straining; and a lump behind my right ear. No one seems to know what is causing the pain when straining (had brain and neck MRI in March 2012 and radiologist says they look normal, slight bulge at C5, nothing more), and doctor doesn't know about the lump behind my right ear. The tenderness on right side was finally relieved after 6 months with nerve block shots in greater occipital nerve, but this did nothing for pain when straining, or lump. I've searched online about my symptoms and Arnold-Chiari seems to be the only thing that fits - is there anything else that might cause pain during "valsalva maneuvers"? Doc says he sees no Chiari on MRI. Tired of hurting...on Carbamezepine, Hydrocodone and Cyclobenzaprine, sometimes pain still breaks through. Don't want any more drugs. Tried meditation (works great on my back pain) and herbal nervines, no luck on the brain pain. Pain is like a spike in the lower back of my head. Sometimes it travels up along the skull toward my eyes. Sometimes the pressure is awful, like my head is going to explode, mainly in the back of my head where the skull meets the top of the neck. I've also started getting pain in the back of my head when barometric pressure drops. Please, any advice or ideas would be welcomed. I am going back to the neurosurgeon at the end of the month after getting nowhere with D.O. and neurologist. Just need some additional expert opinions, please.
Posted Mon, 28 May 2012 in Stroke
Answered by Dr. Praveen K Nath 7 hours later
Respected madam,

Hello & my best wishes for a speedy & complete recovery.
I have gone through all your history in detail.
You have undergone right MVD craniotomy in Oct 2011.
Symptoms as explained by you are most probably secondary to your craniotomy.

Right retromastoid bulge (behind ears ) is common in MVD craniotomy, possibly due to removal of bone at craniotomy site , and /or due to local bulge of underlying membrane (Dura), or may be secondary to a small pseudomeningocele.

Nothing is required to treat this problem except analgesics on SOS basis.
Very rarely is surgical aspiration needed for pseudomeningocele, when it is too large.

I suggest following remedies for your symptoms

1. Take analgesics on SOS basis for pain

2. try lying down in propped up position (may be for initial 2-3 months)

3. Keep regular follow up with your neurosurgeon +/- repeat MRI brain

4. You can occasionally use local crepe bandage compression, if bulge is troubling you.

Get well soon

Dr XXXXXXX k XXXXXXX XXXXXXX consultant neurosurgeon
Above answer was peer-reviewed by
Follow-up: Had MVD craniotomy for Trigeminal Neuralgia. TN better. Why is there tenderness in scalp, pain while sneezing? 3 hours later
Thank you for response on lump. He did find a bone spur he had to remove w/drill. Surgery took almost 8 hours. What about the pain when coughing, sneezing, straining? Does it seem like there might be a cranial pressure problem? I searched these symptoms and the only thing I can find online for my type of pain is Arnold-Chiari Malformation, which seems unlikely. Do you know of any other conditions that could cause severe head pain when coughing, sneezing, straining? Thank you.
Answered by Dr. Praveen K Nath 20 hours later
Thanks for writing back.
Your episodic headache on coughing, sneezing etc looks to be secondary to valsalva effect. In this, whenever there is forced exhalation with a closed airway, the pressure in the middle ear rises and the venous return reduces. This could be leading the headache. XXXXXXX chiari syndrome is very well ruled out by MRI of the brain and CV junction. Your symptoms are unlikely to be secondary to XXXXXXX chiari malformation
This headache should resolve gradually with time.

Hope this helps.
Dr Praveen K Nath XXXXXXX Consultant Neurosurgeon
Above answer was peer-reviewed by
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