A Contemporary Perspective on the Management of Post-Craniotomy Headache and Pain

This article discusses the etiology and management of post-craniotomy headache and pain. A review of available as well as investigatory treatment modalities is offered, followed by suggestions for optimal management of post-craniotomy headache.Recent FindingsThere is a dearth of evidence-based practice regarding the differential diagnosis, natural history, and management of post-craniotomy headache. The etiology of post-craniotomy headache is typically multifactorial, with patients ’ medical history, type of craniotomy, and perioperative management all playing a role. Post-craniotomy headaches are often undertreated, yet available evidence supports a multimodal approach for both prophylaxis and management. Many therapeutic techniques that aim to treat or prevent post-craniot omy headache require more robust validation than clinical evidence currently imparts. Pre- and intraoperative locoregional anesthesia should be the mainstay of prophylaxis; the role of opiates co-administered with analgesics, corticosteroids, and antiepileptic therapy in the acute perioperative phas e is of paramount importance. Treatment of chronic PCH is less well-defined but should involve trials of analgesic, antineuropathic, and antiepileptic medications before enlisting experimental treatments. Comorbid psychiatric, musculoskeletal, or seizure disorders should be managed distinctly from p ost-craniotomy headaches. In patients failing all extant therapies, experimental approaches should be consider...
Source: Current Pain and Headache Reports - Category: Neurology Source Type: research