Postcraniotomy Headache

BACKGROUND: Persistent headache following craniotomy has been reported in the past, but the clinical features of this condition have not been well described. OBJECTIVE: This study was undertaken to evaluate the incidence and clinical features of postcraniotomy headache. METHODS: The medical records of 107 patients who had undergone surgery for brain tumor or intractable epilepsy were reviewed. The clinical features of preoperative and postoperative headache and any headache therapy initiated were obtained from the medical records. The surgical site and the underlying pathology were documented. The subsequent course of the headache also was recorded. RESULTS: We evaluated 102 patients who underwent surgery: 76 for an underlying brain tumor, 21 for intractable epilepsy, and 5 for intracranial hemorrhage. Five patients were disqualified because of inadequate documentation. Fifty-eight patients did not complain of headache preoperatively. Eleven patients who did not have preoperative headache experienced headache postoperatively. Eight had undergone surgery for intractable epilepsy and 3 for brain tumor. Eighty-two percent of these patients experienced gradual resolution of their headaches over time, and most did not require major medical intervention for controlling their headache. No cases of debilitating headaches were identified. The majority of the headaches were located over the surgical site. CONCLUSIONS: The pathogenesis of postoperative headache remains unclear. The clinical characteristics of the headache following craniotomy suggest a combination of tension-type and "site-of-injury headache" overlying the surgical site. These headaches are similar to the headaches described following head trauma.