Post-craniotomy headache: a clinical view with a focus on the persistent form.

Area of Science:

• Neurosurgery
• Headache Medicine
• Pain Management

Background:

• Post-craniotomy headache is a common and challenging complication following neurosurgical procedures.
• It presents a significant issue for neurosurgeons, neurologists, and headache specialists.

Purpose of the Study:

• To review the causes, characteristics, and management strategies for post-craniotomy headaches.
• To highlight the impact of these headaches on patient quality of life and identify research needs.

Main Methods:

• This study was conducted as a narrative review of existing literature on post-craniotomy headaches.

Main Results:

• Potential causes include surgical trauma, dural adherence, nerve injury, scar neuromas, and central sensitization.
• Preventive strategies involve smaller craniotomies, bone replacement, cranioplasty, and local anesthesia infiltration.
• Headaches typically manifest early post-operation, are ipsilateral to the surgical site, and improve over time, often associated with depression, anxiety, and temporomandibular disorders.
• Abortive treatments include analgesics, NSAIDs, triptans, opioids, with some evidence for sodium divalproex, verapamil, and local anesthetics.

Conclusions:

• Post-craniotomy headaches significantly impact patients' quality of life.
• There is a critical need for rigorous clinical trials to evaluate and establish effective therapeutic options for this condition.