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Current Pain and Headache Reports

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01-05-2022 | Craniotomy | Acute Pain Medicine (R Urman, Section Editor)

Postcraniotomy Headache: Etiologies and Treatments

Authors: Corina Bello, Lukas Andereggen, Markus M. Luedi, Christian M. Beilstein

Published in: Current Pain and Headache Reports | Issue 5/2022

Abstract

Purpose of Review

Postcraniotomy headache (PCH) is a highly underappreciated and very common adverse event following craniotomy.

Recent Findings

Analgetic medication with opioids often interferes with neurologic evaluation in the acute phase of recovery and should be kept to a minimal, in general, in the treatment of chronic pain as well. We provide an update on the latest evidence for the management of acute and chronic PCH.

Summary

Especially in the neurosurgical setting, enhanced recovery after surgery protocols need to include a special focus on pain control. Patients at risk of developing chronic pain must be identified and treated as early as possible.

De Benedittis G, Lorenzetti A, Migliore M, Spagnoli D, Tiberio F, Villani RM. Postoperative pain in neurosurgery: a pilot study in brain surgery. Neurosurgery. 1996;38(3):466–9; discussion 9–70. https://doi.org/10.1097/00006123-199603000-00008.

Peón AU, Diccini S. Postoperative pain in craniotomy. Rev Lat Am Enfermagem. 2005;13(4):489–95. https://doi.org/10.1590/s0104-11692005000400005.CrossRefPubMed

Rocha-Filho PA, Gherpelli JL, de Siqueira JT, Rabello GD. Post-craniotomy headache: characteristics, behaviour and effect on quality of life in patients operated for treatment of supratentorial intracranial aneurysms. Cephalalgia : an international journal of headache. 2008;28(1):41–8. https://doi.org/10.1111/j.1468-2982.2007.01465.x.CrossRef

Leslie K, Troedel S, Irwin K, Pearce F, Ugoni A, Gillies R, et al. Quality of recovery from anesthesia in neurosurgical patients. Anesthesiology. 2003;99(5):1158–65. https://doi.org/10.1097/00000542-200311000-00024.CrossRefPubMed

Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia: Int J Headache. 2018;38(1):1–211. https://doi.org/10.1177/0333102417738202.

Haldar R, Kaushal A, Gupta D, Srivastava S, Singh PK. Pain following craniotomy: reassessment of the available options. Biomed Res Int. 2015;2015: 509164. https://doi.org/10.1155/2015/509164.CrossRefPubMedPubMedCentral

Andereggen L, Frey J, Andres RH, El-Koussy M, Beck J, Seiler RW et al. 10-year follow-up study comparing primary medical vs. surgical therapy in women with prolactinomas. Endocrine. 2017;55(1):223–30. https://doi.org/10.1007/s12020-016-1115-2.

Andereggen L, Frey J, Andres RH, Luedi MM, Widmer HR, Beck J, et al. Persistent bone impairment despite long-term control of hyperprolactinemia and hypogonadism in men and women with prolactinomas. Sci Rep. 2021;11(1):5122. https://doi.org/10.1038/s41598-021-84606-x.CrossRefPubMedPubMedCentral

Andereggen L, Mono ML, Kellner-Weldon F, Christ E. Cluster headache and macroprolactinoma: case report of a rare, but potential important causality. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2017;40:62–4. https://doi.org/10.1016/j.jocn.2017.01.028.CrossRef

10.

Ferreira Kdos S, Dach F, Speciali JG. Scar neuromas as triggers for headache after craniotomy: clinical evidence. Arq Neuropsiquiatr. 2012;70(3):206–9. https://doi.org/10.1590/s0004-282x2012000300010.CrossRefPubMed

11.

Rimaaja T, Haanpää M, Blomstedt G, Färkkilä M. Headaches after acoustic neuroma surgery. Cephalalgia : an international journal of headache. 2007;27(10):1128–35. https://doi.org/10.1111/j.1468-2982.2007.01410.x.CrossRef

12.

• Yang L, Kaye AD, Venakatesh AG, Green MS, Asgarian CD, Luedi MM et al. Enhanced recovery after cardiac surgery: an update on clinical implications. Int Anesthesiol Clin. 2017;55(4):148–62. https://doi.org/10.1097/aia.0000000000000168. This article highlights the complex interaction of pain with other factors to be considered in enhanced recovery programmes.

13.

Braun M, Bello C, Riva T, Hönemann C, Doll D, Urman RD, et al. Quantitative sensory testing to predict postoperative pain. Curr Pain Headache Rep. 2021;25(1):3. https://doi.org/10.1007/s11916-020-00920-5.CrossRefPubMedPubMedCentral

14.

Mayberg TS, Lam AM, Matta BF, Domino KB, Winn HR. Ketamine does not increase cerebral blood flow velocity or intracranial pressure during isoflurane/nitrous oxide anesthesia in patients undergoing craniotomy. Anesth Analg. 1995;81(1):84–9. https://doi.org/10.1097/00000539-199507000-00017.CrossRefPubMed

15.

Markovic-Bozic J, Karpe B, Potocnik I, Jerin A, Vranic A, Novak-Jankovic V. Effect of propofol and sevoflurane on the inflammatory response of patients undergoing craniotomy. BMC Anesthesiol. 2016;16:18. https://doi.org/10.1186/s12871-016-0182-5.CrossRefPubMedPubMedCentral

16.

Mordhorst C, Latz B, Kerz T, Wisser G, Schmidt A, Schneider A, et al. Prospective assessment of postoperative pain after craniotomy. J Neurosurg Anesthesiol. 2010;22(3):202–6. https://doi.org/10.1097/ANA.0b013e3181df0600.CrossRefPubMed

17.

Dunn LK, Naik BI, Nemergut EC, Durieux ME. Post-craniotomy pain management: beyond opioids. Curr Neurol Neurosci Rep. 2016;16(10):93. https://doi.org/10.1007/s11910-016-0693-y.CrossRefPubMed

18.

Palmer JD, Sparrow OC, Iannotti F. Postoperative hematoma: a 5-year survey and identification of avoidable risk factors. Neurosurgery. 1994;35(6):1061–4; discussion 4–5. https://doi.org/10.1227/00006123-199412000-00007.

19.

Jones SJ, Cormack J, Murphy MA, Scott DA. Parecoxib for analgesia after craniotomy. Br J Anaesth. 2009;102(1):76–9. https://doi.org/10.1093/bja/aen318.CrossRefPubMed

20.

Rahimi SY, Vender JR, Macomson SD, French A, Smith JR, Alleyne CH, Jr. Postoperative pain management after craniotomy: evaluation and cost analysis. Neurosurgery. 2006;59(4):852–7; discussion 7. https://doi.org/10.1227/01.neu.0000232646.35678.d8.

21.

Sebode M, Lohse AW, Schramm C. Metamizole has been overlooked as a trigger for acute liver injury and acute liver failure. Deutsches Arzteblatt international. 2020;117(37):610. https://doi.org/10.3238/arztebl.2020.0610a.CrossRefPubMedPubMedCentral

22.

Peng Y, Zhang W, Kass IS, Han R. Lidocaine reduces acute postoperative pain after supratentorial tumor surgery in the PACU: a secondary finding from a randomized, controlled trial. J Neurosurg Anesthesiol. 2016;28(4):309–15. https://doi.org/10.1097/ana.0000000000000230.CrossRefPubMed

23.

Rajan S, Hutcherson MT, Sessler DI, Kurz A, Yang D, Ghobrial M, et al. The effects of dexmedetomidine and remifentanil on hemodynamic stability and analgesic requirement after craniotomy: a randomized controlled trial. J Neurosurg Anesthesiol. 2016;28(4):282–90. https://doi.org/10.1097/ana.0000000000000221.CrossRefPubMed

24.

• Song J, Ji Q, Sun Q, Gao T, Liu K, Li L. The opioid-sparing effect of intraoperative dexmedetomidine infusion after craniotomy. Journal Neurosurg Anesthesiol. 2016;28(1):14–20. https://doi.org/10.1097/ana.0000000000000190. This study established the intraoperative use of dexmedetomidine to reduce cumulative morphine consumption and adverse effects after craniotomy.

25.

Himmelseher S, Durieux ME. Ketamine for perioperative pain management. Anesthesiology. 2005;102(1):211–20. https://doi.org/10.1097/00000542-200501000-00030.CrossRefPubMed

26.

Misra S, Parthasarathi G, Vilanilam GC. The effect of gabapentin premedication on postoperative nausea, vomiting, and pain in patients on preoperative dexamethasone undergoing craniotomy for intracranial tumors. J Neurosurg Anesthesiol. 2013;25(4):386–91. https://doi.org/10.1097/ANA.0b013e31829327eb.CrossRefPubMed

27.

• Luedi MM, Singh SK, Mosley JC, Hassan ISA, Hatami M, Gumin J et al. Dexamethasone-mediated oncogenicity in vitro and in an animal model of glioblastoma. Journal Neurosurg. 2018;129(6):1446–55. https://doi.org/10.3171/2017.7.jns17668. This study describes the tumorigenic effect of dexamethasone on glioblastoma in vivo.

28.

Luedi MM, Singh SK, Mosley JC, Hatami M, Gumin J, Sulman EP, et al. A dexamethasone-regulated gene signature is prognostic for poor survival in glioblastoma patients. J Neurosurg Anesthesiol. 2017;29(1):46–58. https://doi.org/10.1097/ana.0000000000000368.CrossRefPubMedPubMedCentral

29.

Hendler N, Cashen A, Morrison C, Long D, Holliday M. Divalproex sodium and other medications for headache following craniotomy for acoustic neuroma. Headache. 1995;35(8):490–3. https://doi.org/10.1111/j.1526-4610.1995.hed3508490.x.CrossRefPubMed

30.

Silberstein SD. Divalproex sodium in headache: literature review and clinical guidelines. Headache. 1996;36(9):547–55. https://doi.org/10.1046/j.1526-4610.1996.3609547.x.CrossRefPubMed

31.

Packard RC. Treatment of chronic daily posttraumatic headache with divalproex sodium. Headache. 2000;40(9):736–9. https://doi.org/10.1046/j.1526-4610.2000.00128.x.CrossRefPubMed

32.

Sauter AR, Luedi MM. Effective treatment of pain by blocking techniques within a multimodal treatment concept. Anaesthesist. 2020;69(12):857–9. https://doi.org/10.1007/s00101-020-00834-2.CrossRefPubMed

33.

Luedi MM, Upadek V, Vogt AP, Steinfeldt T, Eichenberger U, Sauter AR. A Swiss nationwide survey shows that dual guidance is the preferred approach for peripheral nerve blocks. Sci Rep. 2019;9(1):9178. https://doi.org/10.1038/s41598-019-45700-3.CrossRefPubMedPubMedCentral

34.

Chowdhury T, Baron K, Cappellani RB. Severe bradycardia during scalp nerve block in patient undergoing awake craniotomy. Saudi J Anaesth. 2013;7(3):356–7. https://doi.org/10.4103/1658-354x.115344.CrossRefPubMedPubMedCentral

35.

Licina A, Russell J, Silvers A, Jin X, Denny J. Subcutaneous sumatriptan for the treatment of postcraniotomy pain (SUPS trial): protocol for a randomised double-blinded placebo controlled trial. BMJ Open. 2019;9(8): e032388. https://doi.org/10.1136/bmjopen-2019-032388.CrossRefPubMedPubMedCentral

36.

Bijanki KR, Manns JR, Inman CS, Choi KS, Harati S, Pedersen NP, et al. Cingulum stimulation enhances positive affect and anxiolysis to facilitate awake craniotomy. J Clin Investig. 2019;129(3):1152–66. https://doi.org/10.1172/jci120110.CrossRefPubMedPubMedCentral

37.

Lutman B, Bloom J, Nussenblatt B, Romo V. A contemporary perspective on the management of post-craniotomy headache and pain. Curr Pain Headache Rep. 2018;22(10):69. https://doi.org/10.1007/s11916-018-0722-4.CrossRefPubMed

38.

Yu EH, Tran DH, Lam SW, Irwin MG. Remifentanil tolerance and hyperalgesia: short-term gain, long-term pain? Anaesthesia. 2016;71(11):1347–62. https://doi.org/10.1111/anae.13602.CrossRefPubMed

39.

Vadivelu N, Kai AM, Tran D, Kodumudi G, Legler A, Ayrian E. Options for perioperative pain management in neurosurgery. J Pain Res. 2016;9:37–47. https://doi.org/10.2147/jpr.s85782.CrossRefPubMedPubMedCentral

40.

Vacas S, Van de Wiele B. Designing a pain management protocol for craniotomy: a narrative review and consideration of promising practices. Surg Neurol Int. 2017;8:291. https://doi.org/10.4103/sni.sni_301_17.CrossRefPubMedPubMedCentral

41.

Marcus DA. Serotonin and its role in headache pathogenesis and treatment. Clin J Pain. 1993;9(3):159–67. https://doi.org/10.1097/00002508-199309000-00002.CrossRefPubMed

42.

Cavallotti D, Artico M, De Santis S, Iannetti G, Cavallotti C. Catecholaminergic innervation of the human dura mater involved in headache. Headache. 1998;38(5):352–5. https://doi.org/10.1046/j.1526-4610.1998.3805352.x.CrossRefPubMed

43.

Artico M, Cavallotti C. Catecholaminergic and acetylcholine esterase containing nerves of cranial and spinal dura mater in humans and rodents. Microsc Res Tech. 2001;53(3):212–20. https://doi.org/10.1002/jemt.1085.CrossRefPubMed

44.

Luedi MM, Schober P, Hammoud B, Andereggen L, Hoenemann C, Doll D. Preoperative pressure pain threshold is associated with postoperative pain in short-stay anorectal surgery: a prospective observational study. Anesth Analg. 2021;132(3):656–62. https://doi.org/10.1213/ane.0000000000005072.CrossRefPubMed

45.

Diamond S, Baltes BJ. Chronic tension headache–treated with amitriptyline–a double-blind study. Headache. 1971;11(3):110–6. https://doi.org/10.1111/j.1526-4610.1971.hed1103110.x.CrossRefPubMed

46.

Moore KA, Baba H, Woolf CJ. Gabapentin– actions on adult superficial dorsal horn neurons. Neuropharmacology. 2002;43(7):1077–81. https://doi.org/10.1016/s0028-3908(02)00226-5.CrossRefPubMed

47.

Serpell MG. Gabapentin in neuropathic pain syndromes: a randomised, double-blind, placebo-controlled trial. Pain. 2002;99(3):557–66. https://doi.org/10.1016/s0304-3959(02)00255-5.CrossRefPubMed

48.

Karst M, Rollnik JD, Fink M, Reinhard M, Piepenbrock S. Pressure pain threshold and needle acupuncture in chronic tension-type headache–a double-blind placebo-controlled study. Pain. 2000;88(2):199–203. https://doi.org/10.1016/s0304-3959(00)00315-8.CrossRefPubMed

49.

Sandner-Kiesling A, Rumpold Seitlinger G, Dorn C, Koch H, Schwarz G. Lamotrigine monotherapy for control of neuralgia after nerve section. Acta Anaesthesiol Scand. 2002;46(10):1261–4. https://doi.org/10.1034/j.1399-6576.2002.461014.x.CrossRefPubMed

50.

Rollnik JD, Karst M, Fink M, Dengler R. Botulinum toxin type A and EMG: a key to the understanding of chronic tension-type headaches? Headache. 2001;41(10):985–9. https://doi.org/10.1046/j.1526-4610.2001.01193.x.CrossRefPubMed

51.

Zwart JA, Bovim G, Sand T, Sjaastad O. Tension headache: botulinum toxin paralysis of temporal muscles. Headache. 1994;34(8):458–62. https://doi.org/10.1111/j.1526-4610.1994.hed3408458.x.CrossRefPubMed

52.

Matta BF, Menon DK, Turner JM. Textbook of neuroanaesthesia and critical care. Cambridge University Press. 2000.

53.

Perucca E. Pharmacological and therapeutic properties of valproate: a summary after 35 years of clinical experience. CNS Drugs. 2002;16(10):695–714. https://doi.org/10.2165/00023210-200216100-00004.CrossRefPubMed

54.

Maxwell LG, Buckley GM, Kudchadkar SR, Ely E, Stebbins EL, Dube C, et al. Pain management following major intracranial surgery in pediatric patients: a prospective cohort study in three academic children’s hospitals. Paediatr Anaesth. 2014;24(11):1132–40. https://doi.org/10.1111/pan.12489.CrossRefPubMedPubMedCentral

55.

Teo JH, Palmer GM, Davidson AJ. Post-craniotomy pain in a paediatric population. Anaesth Intensive Care. 2011;39(1):89–94. https://doi.org/10.1177/0310057x1103900115.CrossRefPubMed

56.

Gaither JR, Leventhal JM, Ryan SA, Camenga DR. National trends in hospitalizations for opioid poisonings among children and adolescents, 1997 to 2012. JAMA Pediatr. 2016;170(12):1195–201. https://doi.org/10.1001/jamapediatrics.2016.2154.CrossRefPubMedPubMedCentral

57.

Nesvick CL, Oushy S, Daniels DJ, Ahn ES. Safety of immediate use of nonsteroidal antiinflammatory drugs after pediatric craniotomy for tumor. Journal of neurosurgery Pediatrics. 2020:1–7. https://doi.org/10.3171/2020.4.peds2055.

58.

Xing F, An LX, Xue FS, Zhao CM, Bai YF. Postoperative analgesia for pediatric craniotomy patients: a randomized controlled trial. BMC Anesthesiol. 2019;19(1):53. https://doi.org/10.1186/s12871-019-0722-x.CrossRefPubMedPubMedCentral

59.

Xiong W, Li L, Bao D, Wang Y, Liang Y, Lu P, et al. Postoperative analgesia of scalp nerve block with ropivacaine in pediatric craniotomy patients: a protocol for a prospective, randomized, placebo-controlled, double-blinded trial. Trials. 2020;21(1):580. https://doi.org/10.1186/s13063-020-04524-7.CrossRefPubMedPubMedCentral

60.

Zhao C, Jia Y, Jia Z, Xiao X, Luo F. Pre-emptive scalp infiltration with ropivacaine plus methylprednisolone versus ropivacaine alone for relief of postoperative pain after craniotomy in children (RP/MP vs RP): a study protocol for a randomised controlled trial. BMJ Open. 2019;9(6): e027864. https://doi.org/10.1136/bmjopen-2018-027864.CrossRefPubMedPubMedCentral

61.

Sudheer PS, Logan SW, Terblanche C, Ateleanu B, Hall JE. Comparison of the analgesic efficacy and respiratory effects of morphine, tramadol and codeine after craniotomy. Anaesthesia. 2007;62(6):555–60. https://doi.org/10.1111/j.1365-2044.2007.05038.x.CrossRefPubMed

62.

Goldsack C, Scuplak SM, Smith M. A double-blind comparison of codeine and morphine for postoperative analgesia following intracranial surgery. Anaesthesia. 1996;51(11):1029–32. https://doi.org/10.1111/j.1365-2044.1996.tb14997.x.CrossRefPubMed

63.

Jeffrey HM, Charlton P, Mellor DJ, Moss E, Vucevic M. Analgesia after intracranial surgery: a double-blind, prospective comparison of codeine and tramadol. Br J Anaesth. 1999;83(2):245–9. https://doi.org/10.1093/bja/83.2.245.CrossRefPubMed

64.

Cold GE, Felding M. Even small doses of morphine might provoke “luxury perfusion” in the postoperative period after craniotomy. Neurosurgery. 1993;32(2):327. https://doi.org/10.1097/00006123-199302000-00032.CrossRefPubMed

65.

Morad AH, Winters BD, Yaster M, Stevens RD, White ED, Thompson RE, et al. Efficacy of intravenous patient-controlled analgesia after supratentorial intracranial surgery: a prospective randomized controlled trial. Clinical article. J Neurosurg. 2009;111(2):343–50. https://doi.org/10.3171/2008.11.jns08797.CrossRefPubMed

66.

Kelly KP, Janssens MC, Ross J, Horn EH. Controversy of non-steroidal anti-inflammatory drugs and intracranial surgery: et ne nos inducas in tentationem? Br J Anaesth. 2011;107(3):302–5. https://doi.org/10.1093/bja/aer230.CrossRefPubMed

Title: Postcraniotomy Headache: Etiologies and Treatments
Authors: Corina Bello
Lukas Andereggen
Markus M. Luedi
Christian M. Beilstein
Publication date: 01-05-2022
Publisher: Springer US
Keywords: Craniotomy
Opioids
Opioids
Postoperative Nausea and Vomiting
Morphine
Headache
Published in: Current Pain and Headache Reports / Issue 5/2022
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI: https://doi.org/10.1007/s11916-022-01036-8

2024 ASCO Annual Meeting

Springer Medicine

Postcraniotomy Headache: Etiologies and Treatments

Abstract

Purpose of Review

Recent Findings

Summary

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

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