Postsurgical Headaches and Their Management
In the past for patients undergoing craniotomies and craniectomies, headache was not identified as a significant complication of their procedure. However, there are a myriad of headache- and pain-related issues that arise in the post-craniotomy period. This pain can be acute pain or chronic pain. Acute pain arises in the postoperative period up to 2 months postsurgical intervention. Chronic pain occurs or persists 2 months after intervention and beyond. These headaches and pain syndromes are further subdivided by phenotype, type of surgery, and surgical approach. Focused management of acute postsurgical headaches can improve short-term outcomes and decrease analgesic-related ICU complications. Tailored therapy in chronic headache cases can improve quality of life. Chronic postsurgical headaches appear to mirror their nonsurgical counterparts in terms of therapy. It is important to recognize that these syndromes can arise in the postoperative period. There are a number of postsurgical syndromes associated with headaches that should be identified to facilitate treatment.
KeywordsPostsurgical Migraine Cluster CSF hypotension Overuse Trephine Endarterectomy Hemicranias Craniotomy Craniectomy
- 1.Cutrer FM. Pain sensitive cranial structures: chemical anatomy. In: Silberstein SD, Lipton RB, Dalessio DJ, editors. Wolff's headache and other head pain. 7th ed. New York, NY: Oxford UP; 2001. p. 50–5.Google Scholar
- 2.Dunne PB. Anatomy and physiology of headache. In: Tollison CD, Kunkel RS, editors. Headache: diagnosis and treatment. Baltimore: Williams & Wilkins; 1993. p. 13–7. Print.Google Scholar
- 3.Renehan WE, Jacquin MF. Anatomy of central nervous system pathways related to head pain. In: Olesen J, Tfelt-Hansen P, KMA W, editors. The headaches. New York, NY: Raven; 1993. p. 77–86.Google Scholar
- 5.Yasargil MG, Smith RD. Management of aneurysms of anterior circulation by intracranial procedures. In: Youmans JR, editor. Youmans neurological surgery. Vol 3. 2nd ed. Philadelphia, PA: W.B. Saunders; 1982. p. 1663–96.Google Scholar
- 9.Olesen J, et al. The international classification of headache disorders. 2nd ed (ICHD-II). Revue Neurologique. 2005;161.6-7:689–91. Web.Google Scholar
- 10.Santos CMT, et al. Options to manage post-craniotomy acute pain: no protocol available. Rev Chil Neurocirugía. 2013;39:22–7. Web.Google Scholar
- 28.ICHD-3 beta—the international classification of headache disorders. 3rd ed (Beta Version). International Headache Society, n.d. Web. 15 Mar 2017. https://www.ichd-3.org/.