Evaluation of post-craniotomy headache management: A single-center retrospective study

Area of Science:

• Neurosurgery
• Pain Management
• Anesthesiology

Background:

• Post-craniotomy headache (PCH) is a frequent complication following brain surgery.
• Inadequate pain management for PCH can lead to increased morbidity and mortality.
• Current PCH treatments have limitations, necessitating evaluation of pain management efficacy.

Purpose of the Study:

• To assess the effectiveness of current pain management strategies for patients undergoing elective craniotomy.
• To explore the relationship between pain control and hospital length of stay (LOS).
• To identify factors contributing to uncontrolled PCH and the timing of its occurrence.

Main Methods:

• A single-center, retrospective study involving adult patients undergoing elective craniotomy for neoplasms or epilepsy.
• Inclusion criteria included a post-operative length of stay (LOS) of 48 hours or more.
• Data collection focused on pain scores, LOS, and patient demographics to identify factors associated with uncontrolled pain.

Main Results:

• One hundred patients were analyzed; 75 for neoplasm excision and 25 for epilepsy.
• Median pain scores were higher on postoperative day (POD) 0 compared to POD 1-3 (P=0.043).
• Uncontrolled pain occurred in 33% of patients, primarily on POD 0 and 1. Female sex, migraine history, younger age, and epilepsy procedures were associated with uncontrolled pain.

Conclusions:

• Current pain management effectively controls post-craniotomy headache (PCH) in most patients.
• The initial postoperative period (POD 0-1) presents the highest risk for uncontrolled PCH.
• Targeted pain management optimization for at-risk individuals and further multicenter research are recommended.