Risk factors and analysis of long-term headache in sporadic vestibular schwannoma: A multicenter cross-sectional study

Matthew L. Carlson, Øystein Vesterli Tveiten, Colin L. Driscoll, Christopher J. Boes, Molly J. Sullan, Frederik K. Goplen, Morten Lund-Johansen, Michael J. Link

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

OBJECT: 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.

Original languageEnglish (US)
Pages (from-to)1276-1286
Number of pages11
JournalJournal of Neurosurgery
Volume123
Issue number5
DOIs
StatePublished - Nov 1 2015

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Acoustic Neuroma
Statistical Factor Analysis
Headache
Cross-Sectional Studies
Microsurgery
Hospital Inventories
Therapeutics
Anxiety
Observation
Depression
Equipment and Supplies
Neoplasms
Headache Disorders
Population Control
Radiosurgery
Age Factors
Observational Studies
Surveys and Questionnaires
Counseling
Mental Health

Keywords

  • Acoustic neuroma
  • Cephalgia
  • Cerebellopontine angle
  • Gamma Knife radiosurgery
  • Headache
  • Microsurgery
  • Oncology
  • Pain
  • Stereotactic radiosurgery
  • Vestibular schwannoma

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Medicine(all)

Cite this

Carlson, M. L., Tveiten, Ø. V., Driscoll, C. L., Boes, C. J., Sullan, M. J., Goplen, F. K., ... Link, M. J. (2015). Risk factors and analysis of long-term headache in sporadic vestibular schwannoma: A multicenter cross-sectional study. Journal of Neurosurgery, 123(5), 1276-1286. https://doi.org/10.3171/2014.12.JNS142109

Risk factors and analysis of long-term headache in sporadic vestibular schwannoma : A multicenter cross-sectional study. / Carlson, Matthew L.; Tveiten, Øystein Vesterli; Driscoll, Colin L.; Boes, Christopher J.; Sullan, Molly J.; Goplen, Frederik K.; Lund-Johansen, Morten; Link, Michael J.

In: Journal of Neurosurgery, Vol. 123, No. 5, 01.11.2015, p. 1276-1286.

Research output: Contribution to journalArticle

Carlson, ML, Tveiten, ØV, Driscoll, CL, Boes, CJ, Sullan, MJ, Goplen, FK, Lund-Johansen, M & Link, MJ 2015, 'Risk factors and analysis of long-term headache in sporadic vestibular schwannoma: A multicenter cross-sectional study', Journal of Neurosurgery, vol. 123, no. 5, pp. 1276-1286. https://doi.org/10.3171/2014.12.JNS142109
Carlson, Matthew L. ; Tveiten, Øystein Vesterli ; Driscoll, Colin L. ; Boes, Christopher J. ; Sullan, Molly J. ; Goplen, Frederik K. ; Lund-Johansen, Morten ; Link, Michael J. / Risk factors and analysis of long-term headache in sporadic vestibular schwannoma : A multicenter cross-sectional study. In: Journal of Neurosurgery. 2015 ; Vol. 123, No. 5. pp. 1276-1286.
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abstract = "OBJECT: 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.",
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AU - Carlson, Matthew L.

AU - Tveiten, Øystein Vesterli

AU - Driscoll, Colin L.

AU - Boes, Christopher J.

AU - Sullan, Molly J.

AU - Goplen, Frederik K.

AU - Lund-Johansen, Morten

AU - Link, Michael J.

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N2 - OBJECT: 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.

AB - OBJECT: 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.

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KW - Gamma Knife radiosurgery

KW - Headache

KW - Microsurgery

KW - Oncology

KW - Pain

KW - Stereotactic radiosurgery

KW - Vestibular schwannoma

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