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Post-Craniotomy Headache: Current Concepts and Emerging Procedural Therapies
Sarah A Friedman1, Arathi Nandyala2
1Department of Neurology, Weill Cornell Medicine, 1305 York Ave, New York, NY, 10021, USA.
Current Pain and Headache Reports
|August 5, 2026
Summary
Post-craniotomy headache (PCH) affects many neurosurgery patients, with a significant portion experiencing persistent pain. Emerging treatments show promise, but a phenotype-driven approach is needed for better management of this common complication.
Area of Science:
- Neurosurgery
- Neurology
- Pain Management
Background:
- Post-craniotomy headache (PCH) is a frequent complication after neurosurgery, impacting 60-70% of patients.
- A substantial subset, nearly 25%, develop persistent PCH, necessitating effective management strategies.
Purpose of the Study:
- To review the current literature on post-craniotomy headache (PCH).
- To summarize recent advancements in procedural therapies for PCH.
- To highlight trends in understanding PCH mechanisms, classification, and management.
Main Methods:
- Literature review of existing studies on post-craniotomy headache.
- Analysis of identified risk factors and proposed classifications.
- Evaluation of current and emerging treatment modalities.
Main Results:
- PCH affects 60-70% of patients, with 25% developing persistent PCH.
- Risk factors include younger age, female sex, pre-existing headaches, and longer surgeries.
- Classification into phenotypes (migrainous, tension-type, etc.) is inconsistent.
- OnabotulinumtoxinA and nerve blocks show emerging therapeutic potential.
- Pharmacological, non-pharmacological, and procedural interventions are supported by evidence.
Conclusions:
- Effective management of PCH requires a phenotype-driven approach.
- Standardized multi-modal protocols and novel therapies, such as CGRP-targeted agents, warrant further investigation.
- Future research should focus on personalized treatment strategies for PCH.
