Chronic headache caused by a titanium fixation plate: Report of two cases

BACKGROUND: We report two patients with chronic postcraniotomy headache who showed rapid alleviation of pain after removal of titanium miniplates. CASE DESCRIPTION: (Case 1) A 26-year-old woman underwent a right frontal craniotomy and excision of the entire cerebral cavernous malformation. Eleven years later, she developed headache. The titanium plate was removed and the patient presented complete amelioration of headache. (Case 2) A 50-year-old man underwent an aneurysm clipping via the lateral supraorbital approach of the left side. One year later, he complained about throbbing pain. Removing the titanium plate led to complete relief of the headache. CONCLUSION: Titanium miniplate fixation may irritate the deep division of the supraorbital nerve and may cause a chronic headache. Here, we propound the idea that, postcraniotomy, titanium miniplates should not be placed above the temporal fusion line.