Abstract
Background The latest third edition of the International Classification of Headache Disorders
delineates diagnostic criteria for acute headache attributed to craniotomy (AHAC),
but data on possible predisposing factors are sparse. This prospective observational
study aims to evaluate the impact of surgery-related muscle incision on the prevalence,
severity, and characteristics of AHAC.
Patients and Methods Sixty-four consecutive adults (mean age: 54.2 ± 15.2 years; 26 males and 38 females)
undergoing cranial neurosurgery for various reasons without preoperative headache
were included. After regaining consciousness, all patients reported their average
daily headache on a numeric pain rating scale (NRS; range: 0–10), headache characteristics,
as well as analgesic consumption from day 1 to 3 after surgery. Three distinct patient
cohorts were built with respect to the surgical approach (craniotomy ± muscle incision;
burr hole surgery) and group comparisons were performed. Additionally, patients with
AHAC ≥ 3 NRS were reevaluated at 7.2 ± 2.3 months following treatment by means of
standardized questionnaires to determine the prevalence of persistent headache attributed
to craniotomy as well as headache-related disability and quality of life.
Results Thirty of 64 (46.9%) patients developed moderate to severe AHAC (NRS ≥ 3) after cranial
neurosurgery. There were no significant group differences with regard to age, gender,
or general health condition (American Society of Anesthesiologists Physical Status
Classification). Craniotomy patients with muscle incision suffered from significantly
higher early postoperative mean NRS scores compared with their counterparts without
procedure-related muscle injury (3.4 ± 2.3 vs. 2.3 ± 1.9) as well as patients undergoing
burr hole surgery (1.2 ± 1.4; p = 0.02). Moreover, the consumption of nonopioid analgesics was almost doubled following
muscle-transecting surgery as compared with muscle-preserving procedures (p = 0.03). Young patient age (odds ratio/95% confidence interval for each additional
year: 0.93/0.88–0.97) and surgery-related muscle injury (5.23/1.62–19.41) were identified
as major risk factors for the development of AHAC ≥ 3 NRS. There was a nonsignificant
trend toward higher pain chronification rate as well as headache-related disability
after craniotomy with muscle injury.
Conclusion Surgery-related muscle damage may be an important predisposing factor for AHAC. Therefore,
if a transmuscular approach is unavoidable, the neurosurgeon should be aware of the
need for adequately adjusted intra- and postoperative analgesia in these cases.
Keywords
secondary headache disorders - craniotomy - postcraniotomy headache - acute headache
attributed to craniotomy - neurosurgery
