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Erschienen in: Current Pain and Headache Reports 10/2018

01.10.2018 | Anesthetic Techniques in Pain Management (D Wang, Section Editor)

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

verfasst von: Bryan Lutman, Jamie Bloom, Brandon Nussenblatt, Victor Romo

Erschienen in: Current Pain and Headache Reports | Ausgabe 10/2018

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Abstract

Purpose of Review

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 Findings

There 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-craniotomy 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 phase 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 post-craniotomy headaches. In patients failing all extant therapies, experimental approaches should be considered. These include subanesthetic ketamine infusion or surgical site injection with local anesthetics, corticosteroids, or botulinum toxin.

Summary

Post-craniotomy headache is a complex phenomenon with many underutilized treatment options available, and many more under investigation. Nonetheless, further research is required to differentiate the efficacy of contemporary treatment strategies and to elucidate the applicability of novel therapies.
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Metadaten
Titel
A Contemporary Perspective on the Management of Post-Craniotomy Headache and Pain
verfasst von
Bryan Lutman
Jamie Bloom
Brandon Nussenblatt
Victor Romo
Publikationsdatum
01.10.2018
Verlag
Springer US
Erschienen in
Current Pain and Headache Reports / Ausgabe 10/2018
Print ISSN: 1531-3433
Elektronische ISSN: 1534-3081
DOI
https://doi.org/10.1007/s11916-018-0722-4

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