Postcraniotomy headache

Postcraniotomy headache refers to headaches that occur after a surgical procedure involving the removal of a portion of the skull, typically to access and treat conditions affecting the brain, such as tumors, aneurysms, or traumatic brain injuries. These headaches can vary in intensity and duration and may persist for weeks or months following the surgery.

Several factors contribute to postcraniotomy headaches:

Surgical Trauma: The surgical procedure itself can cause tissue damage and inflammation, leading to headaches.

Brain Swelling: Swelling of the brain tissue after surgery can put pressure on surrounding structures, causing pain.

Changes in Cerebrospinal Fluid (CSF) Dynamics: Alterations in the flow or absorption of cerebrospinal fluid, which surrounds the brain and spinal cord, can contribute to headaches.

Muscle Tension: Muscles in the neck and shoulders may become tense due to positioning during surgery, leading to headache.

Nerve Injury: Damage to nerves during surgery or inflammation of nerves in the area can cause headache.

Medications: Pain medications, anesthesia, and other drugs used during and after surgery may contribute to headaches as side effects.

Managing postcraniotomy headaches typically involves a combination of medications, lifestyle modifications, and other interventions:

Pain Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids may be prescribed to alleviate pain. Muscle Relaxants: These can help reduce tension in the neck and shoulder muscles. Anticonvulsants: Some medications used to prevent seizures, such as gabapentin or pregabalin, can also help with neuropathic pain. Caffeine: In some cases, caffeine can alleviate headache symptoms. Physical Therapy: Gentle exercises and stretching can help relieve muscle tension and improve mobility. Relaxation Techniques: Stress management techniques such as deep breathing, meditation, or biofeedback may help reduce headache frequency and severity. Hydration and Nutrition: Ensuring adequate hydration and maintaining a balanced diet may help prevent headaches. Follow-up Care: Regular follow-up appointments with healthcare providers are essential to monitor recovery and adjust treatment as needed. It's crucial for individuals experiencing postcraniotomy headaches to communicate with their healthcare team to ensure appropriate management and to address any concerns or complications promptly.

Postcraniotomy headache (PCH) is a common adverse event and can lead to various complications and decreased quality of life.

Recent findings: To reduce postcraniotomy pain and associated complications, a multimodal pain therapy including analgesics, analgesic adjuncts, and regional anesthesia is essential. The use of opioids should be minimized to facilitate prompt postoperative neurosurgical assessment. Here, we provide an update on the latest evidence regarding the role of scalp nerve blocks in the pain management of patients undergoing craniotomy procedure. Nerve blocks are effective in alleviating postoperative pain after craniotomy. Scalp blocks contribute to lower pain levels and less opioid consumption in the first 48 h following surgery. Moreover, there is a significant decrease in patients suffering from PONV among patients who receive scalp block ¹⁾