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Prevalence and clinical characterization of headache in patients with cranial bone defects: a single-center
Helbert de Oliveira Manduca Palmiero1,2, Jefferson Rosi3,4,5, Saul Almeida da Silva3
1Division of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil. helbertpalmiero@gmail.com.
Background And Objectives:
Headache is a poorly characterized symptom in patients with residual cranial bone defects. This study aimed to describe the prevalence and clinical features of headache-including intensity, quality, postural modulation, associated symptoms, and relief factors-in a cohort awaiting cranioplasty.
Methods:
A retrospective, cross-sectional study was conducted at a tertiary neurosurgical referral center (January 2016 - May 2026). Adults with residual cranial bone defects following craniotomy were evaluated at a specialized headache clinic. Headache was assessed using the Visual Analogue Scale (VAS), neuropathic features with the DN4 questionnaire, and relief factors were systematically recorded. Descriptive statistics and between-group comparisons (chi-squared, Fisher's exact, and independent-samples t-tests) were conducted.
Results:
Of 182 patients (mean age 45.4 ± 13.0 years; 60.4% male), 112 (61.5%) reported headache. Mean VAS was 5.7 ± 2.2, and 84.0% had at least moderate intensity. Headache was predominantly localized to the defect site (85.7%), with pressure/heaviness (68.8%) and tightness (66.9%) as the leading pain qualities. Neuropathic features were present in 6.2%. Associated symptoms-including vertigo (42.0%), photophobia (24.1%), and phonophobia (23.2%)-occurred exclusively or more frequently in the headache group (all p < 0.01). Relief factors were identified in 67.0% of patients, most commonly dipyrone (50.0%) and recumbency (10.7%).
Conclusion:
Headache affects most patients with cranial bone defects, presenting as a moderate-to-severe, defect-site-predominant syndrome with pressure-mediated features and a rich neurological accompaniment. Systematic headache assessment and evidence-based analgesic protocols are warranted in this population pending cranioplasty.
