Initially, his neurological examination was described to be unremarkable, but he strongly complained of severe migraine-type headaches, that, except for their intensity and daily occurrence, were very similar to the migraines he had experienced before the operation.

He also complained of difficulties falling asleep and it often took him until the early morning until he was able to get some rest.

About 2 months after the operation, he was referred to our specialized headache clinic. Until that time, he had not worked yet and his relationship to his girlfriend had become very difficult, as he had become a completely different person after the operation: without initiative, not sleeping, moderately depressed and about to lose his work due to these changes.

Thereafter, he was treated on monotherapy using valproate, topiramate and lamotrigine for control of both headaches with migrainous phenotype and epileptic discharges. As monotherapies were unsuccessful, combination treatments with additional SNRIs (duloxetine, venlafaxine) were initiated, again, without clinically significant control of his headaches. All of the above treatments were tried in increasing dosages and at high doses for a sufficient length of time.

EEG, that was made every 3 months during the first year after referral, showed a breech rhythm, but was otherwise unremarkable. In one occasion, about 6 months after the operation, the patient came to the emergency unit complaining about excruciating migraine-type headaches, indicating that he was considering suicide. He was admitted to the medical department under neurological supervision, and the EEG showed mild slowing together with serial (up to 2 s) spike-wave complexes in the region of the operation site. Valproate serum levels were low, and, after having both corrected dosage and controlled for regular intake, resulting in therapeutic serum levels, the headaches returned to their previous levels of mostly moderate intensity.

One month after this, he presented routinely in the clinic complaining of a new symptom, which was a bizarre tremor of the legs resulting in difficulties walking, but without falls. He provided the information that he had finally lost both his work and his girlfriend. Another MRI and an EEG recording did not show any unexpected abnormality. His leg tremor was suspected to be of functional origin, which was confirmed by two other neurological colleagues having examined the patient at this occasion.

A psychiatrist was involved and diagnosed a pathological stress reaction with psychosomatic symptoms in addition to the neurological problems. The psychiatric opinion was that the chronic headaches with migrainous phenotype might well be of psychosomatic origin altogether, resulting from the difficulties to adapt to having been diagnosed with a brain tumour. Psychotherapy was initiated on an outpatient basis, without any benefit for 6 months. A subsequent psychosomatic hospitalization was discontinued by the treating psychiatrist because the patient had a tonic-clonic seizure that was diagnosed to be most probably functional in the neurological department where the patient had been brought to.

In the course of the disease, the patient was stabilized as far as his headache and sleep were concerned, but up to now, 2 years after his operation, has not returned to his previous life. He lives on a small invalidity pension and has started to work a few hours per week helping his successor as a chef in the same restaurant he had been prior to his operation.