Intraspinal Foreign Body–Induced Headache: A Case Report

Introduction Patients with intracranial and intraspinal foreign bodies (if there is no lesion of the central nervous system structures) are usually asymptomatic, and when the lesion is present, weakness or numbness may be present. In this report, we present a patient with a foreign body in the spinal canal who developed isolated persistent headache, after initial transient numbness.

Case Report A 30-year-old male suffered clavicle fracture in a motorcycle accident. The fracture was treated with two Kirschner wires, one of which migrated to the spinal canal through T2 foramen on the right and reached opposite foramen at the same level, without spinal cord injury 4 months after initial fixation. The migration of Kirschner wires is a rare but well-known and significant complication of this osteosynthesis method. Migration to the spinal canal is very rare due to almost complete osseous protection of the canal and its structures. The patient developed persistent headache after initial transient numbness that resulted in only ulnar nerve dermatomes bilaterally. Kirschner wire extraction was performed, whereupon the headache desisted. Sporadic headache was still present in the first month after wire extraction, and disappeared completely in the next 3 months.

Discussion Not many cases of foreign body–induced headache were described, nor did all the patients who were diagnosed with intracranial or intraspinal foreign body without meningeal or deeper structures lesion symptomatic. Two cases of patients who suffered headache which was related to homicide attempt in infancy with needles placed into intradural space through frontal fontanel were reported.

Conclusion The pathophysiologic mechanism of the headache was not determined. We consider this phenomenon to be a result of meningeal irritation, as a result of compression of the meninges due to metallic foreign body.

Keywords spine; foreign body; headache; meningeal irritation