CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(02): 250-255
DOI: 10.1055/s-0044-1786702
Research Article

Sumatriptan for Postcraniotomy Headache after Minimally Invasive Craniotomy for Clipping of Aneurysms: A Prospective Randomized Controlled Trial

Lashmi Venkatraghavan
1   Department of Anesthesia and Pain Management, University of Toronto, Toronto Western Hospital, University Health Network, Toronto, Canada
,
Evan Shao
1   Department of Anesthesia and Pain Management, University of Toronto, Toronto Western Hospital, University Health Network, Toronto, Canada
,
1   Department of Anesthesia and Pain Management, University of Toronto, Toronto Western Hospital, University Health Network, Toronto, Canada
,
Michael Dinsmore
1   Department of Anesthesia and Pain Management, University of Toronto, Toronto Western Hospital, University Health Network, Toronto, Canada
,
Tumul Chowdhury
1   Department of Anesthesia and Pain Management, University of Toronto, Toronto Western Hospital, University Health Network, Toronto, Canada
› Author Affiliations
Funding This study was funded by Canadian Anesthesiology Society Research Award in Neuroanesthesia in memory of Adrienne Cheng.

Abstract

Introduction Postcraniotomy headaches are often underestimated and undertreaded. This study aimed to identify if postoperative administration of sumatriptan after minimally invasive craniotomy for clipping an unruptured aneurysm could reduce postcraniotomy headache and improve the quality of postoperative recovery.

Settings and Design Tertiary care center, single-center randomized double-blind placebo-controlled trial.

Materials and Methods Patients who complained of postoperative headaches after minimally invasive craniotomy for clipping of unruptured aneurysms were randomized to receive subcutaneous sumatriptan (6 mg) or placebo. The primary outcome was the quality of recovery measured 24 hours after surgery. Secondary outcomes were total opioid use and headache score at 24 hours after surgery. Data were analyzed using a Student's t-test or the chi-square test.

Results Forty patients were randomized to receive sumatriptan (n = 19) or placebo (n = 21). Both groups had similar demographics, comorbidities, and anesthesia management. The Quality of Recovery 40 score was higher for patients receiving sumatriptan compared to placebo, however, not statistically significant (173 [156–196] vs. 148 [139–181], p = 0.055). Postoperative opioid use between sumatriptan and placebo was lower, but not significant (5.4 vs. 5.6 mg morphine equivalent, p = 0.71). The severity of headache was also not statistically different between the two groups (5 [4–5] vs. 4 [2–5], p = 0.155).

Conclusion In patients undergoing minimally invasive craniotomies for aneurysm clipping, sumatriptan given postoperatively has a nonsignificant trend for a higher quality of recovery. Similarly, there was a nonsignificant trend toward lower postcraniotomy headache scores and opioid scores for the patient given sumatriptan.

Note

Postcraniotomy headaches are often underestimated and undertreaded and have an incidence of 70 to 90%. This study shows that in minimally invasive craniotomy for aneurysm clipping, subcutaneous sumatriptan had a trend toward improved postoperative recovery, postoperative opioid use, and headache severity over placebo. Further research is required to determine which intracranial surgery is sumatriptan most effective at reducing headaches.


Ethical Approval

UHN REB # 12-0139-B, 15th July 2013.


TRIAL REGISTRATION: http://clinicaltrials.gov; registration ID NCT01632657.




Publication History

Article published online:
06 June 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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