THESES
Post-craniotomy headache after surgery for treatment of cerebral aneurysms (Abstract)* * Cefaléia pós-craniotomia em pacientes submetidos à cirurgia para clipagem de aneurismas cerebrais (Resumo). Tese de Doutorado, Universidade de São Paulo (Área: Neurologia). Orientador: José Luiz Dias Gherpelli. . Thesis. São Paulo, 2006.
Pedro Augusto Sampaio Rocha Filho** ** Address: Rua das Creoulas 78/103, 52011-270 Recife PE, Brasil.
INTRODUCTION: Post-craniotomy headache can cause a great repercussion on the quality of life of those who suffer it. However, literature on this subject lacks prospective studies on this condition. We studied the behavior and characteristics of the headache on the first six months after craniotomy.
METHOD: Patients with cerebral aneurysms were evaluated at the Clinics Hospital of the University of São Paulo Medical School, between 10/17/2002 and 10/02/2003 in the pre-surgical period, and followed during six months after the surgery. We used semi-structured interviews, headache diaries, Hospital Anxiety and Depression Scale, Epworth Sleepiness Scale, SF-36 and McGill Pain Questionnaire. Dentists evaluated the presence of temporomandibular disorder in the post-surgical period.
RESULTS: 79 patients were included, with a mean age of 45.3 years, 64.6% were female, and 72 concluded the follow-up. 87 craniotomies were performed (pterional: 89.7%; frontal: 4.6%; orbitozygomatic: 5.8%). Post-craniotomy headache was observed in 91.1%, early in the post-surgical period (4 days), being significantly more precocious in those with headache caused by subarachnoid hemorrhage in the pre-surgical evaluation. There were changes in the headache diagnosis, side and sites, after surgery that did not change during the follow-up period. The frequency of the headache had an average increase of 14 days (median=1) on the first trimester of the pos-surgical period, compared to the trimester before surgery and continued at a rate of 6.9 days (median=0) higher on the second trimester. There was an average decrease of 7.9 days (median=1) from the first to the last three months of follow-up. The presence of subarachnoid hemorrhage did not influence headache frequency. There was a positive relation between headache frequency and depressive and anxiety symptoms. The headache on the second trimester of the post-surgical period was significant related to temporomandibular disorder. Post-craniotomy headache based on the International Headache Society criteria was observed in 40% of the patients (acute in 11.0%; chronic in 30.2%). McGill Pain Questionnaire: PRI was positively and significantly related to the intensity of the anxiety and had lower scores in the pterional approach; the number of words chosen was higher in women. SF-36: the scores were significantly lower than the ones found on a large Brazilian urban sample. The presence of anxiety and frontal craniotomy were associated with significant lower scores on bodily pain domain, and higher headache frequencies were significantly associated with lower scores on bodily pain and social functioning.
CONCLUSION: Post-craniotomy headache had a high incidence, an early beginning, different features and a higher frequency than previous headaches and was associated with temporomandibular disorder, depressive and anxiety symptoms and with a significant repercussion on quality of life. Its frequency decreased with time. Pain was more intense in women, anxious persons and in those with frontal and orbitozygomatic approach.
Key words: headache/classification, craniotomy, pain/postoperative, pain measurement, temporomandibular joint dysfunction syndrome, intracranial aneurysm, quality of life.
Publication Dates
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Publication in this collection
11 Apr 2008 -
Date of issue
Sept 2007
