Persistent headache after supratentorial craniotomy

OBJECTIVE: Although the incidence, possible causes, and treatment of persis tent headache after suboccipital craniotomy have been discussed extensively , few data have been published regarding persistent headache after supraten torial craniotomy. METHODS: We retrospectively analyzed the senior author's patient series of 145 consecutive anterior temporal lobectomies for intractable epilepsy perf ormed during a 9-year period. To eliminate confounding causes of headache, all patients studied were seizure-free, none had progressive mass lesions o r persisting vascular anomalies, and none had major complications of surger y. With the permission of the institutional review board, information on he adache was obtained from patient records, the patients' neurologists, and t he patients themselves. RESULTS: Of the 145 consecutive patients who underwent operations, 126 pati ents had adequate follow-up for analysis. Of the 126 patients, 104 did not have headaches and were not using regular analgesics 2 months postoperative ly. Twenty-two patients had headaches persisting, beyond 2 months, Seven (5 .6%) of the 126 patients had headaches that lasted more than 2 months but l ess than 1 year, and they were free of recurrent headaches 1 year postopera tively. Fifteen (11.9%) of the 126 patients had ongoing headaches 1 year af ter surgery. Regarding headache severity, 4.0% of patients had medically un controlled headaches, and 3.2% continued to require prescription drugs for headaches 1 year postoperatively. CONCLUSION: Although the incidence of persistent head pain after supratento rial craniotomy is lower than that reported for posterior fossa procedures, the incidence is not trivial. The cause of persistent pain deserves furthe r investigation.