Cranial Osteoma with Associated Chronic Headaches: A Case Study

Case at a Glance

A 41-year-old female presents with a painful cranial osteoma causing severe quality of life impairment and triggering frequent migraines. The patient experiences daily pain and functional limitations due to hypersensitivity of the lesion.

Patient's Story

The patient is a 41-year-old female with a medical history significant for frequent migraines (approximately 12 episodes per month), hiatal hernia, and celiac disease. Two years prior to presentation, she noticed the development of a small bony protuberance on the vertex of her skull. She attributes this to repetitive minor head trauma from inadvertently striking her head while securing her child in a car seat. The lesion has become progressively more sensitive, with even minimal contact triggering severe radiating pain that culminates in migraine episodes. Daily activities such as hair brushing, washing, sleeping, and dressing have become significantly impaired due to pain avoidance behaviors.

Initial Assessment

Physical examination revealed a small, firm, bony mass on the cranial vertex that was exquisitely tender to palpation. The patient's pain response was immediate and severe upon gentle contact with the lesion. Neurological examination was otherwise unremarkable. Current medications include Sumatriptan 100mg as needed for migraine management, with usage limited to 9 tablets monthly due to prescribing restrictions.

The Diagnostic Journey

The patient was evaluated by a neurosurgeon who confirmed the clinical diagnosis of cranial osteoma through examination and appropriate imaging studies. The correlation between mechanical stimulation of the osteoma and subsequent migraine episodes was clearly established through patient history and clinical observation.

Final Diagnosis

Cranial osteoma with associated mechanical trigger headaches and chronic migraine syndrome

Treatment Plan

Initial neurosurgical consultation recommended conservative management due to perceived surgical risks outweighing potential benefits. Medical management with Sumatriptan provided temporary relief but was insufficient for long-term symptom control. Multidisciplinary approach recommended including: 1) Re-evaluation with neurosurgery for surgical candidacy assessment given significant quality of life impact, 2) Neurological consultation for comprehensive headache management and consideration of preventive medications such as topiramate or valproate, 3) Trial of anti-inflammatory medications for localized pain control, and 4) Pain management strategies for neuropathic hypersensitivity.

Outcome and Follow-up

The case highlights the importance of individualized risk-benefit analysis in surgical decision-making, particularly when conservative measures fail to provide adequate symptom relief and quality of life remains severely impaired. Ongoing multidisciplinary management focusing on both the structural lesion and associated headache syndrome is essential for optimal patient outcomes.