Sumatriptan improves postoperative quality of recovery and reduces postcraniotomy headache after cranial nerve decompression

Abstract

Background: Microvascular decompression (MVD) is a surgical treatment for cranial nerve disorders via a small craniotomy. The postoperative pain of this procedure can be classified as surgical site somatic pain and postcraniotomy headache similar in nature to a migraine, including its association with photophobia, nausea, and vomiting. This headache can be difficult to treat and can impact on postoperative recovery. Sumatriptan is used to treat migraine-like headaches in various settings. This single-centre randomized controlled trial investigated whether postoperative administration of sumatriptan after MVD surgery impacts the quality of postoperative recovery.

Methods: Fifty patients who complained of postoperative headache after MVD were randomized to receive an s.c. injection of sumatriptan (6 mg) or saline. The primary outcome was quality of recovery as measured by the Quality of Recovery-40 (QoR-40) score at 24 h.

Results: The QoR-40 scores were significantly higher in the sumatriptan group (median 184; interquartile range 169-196) than in the placebo group (133; 119-155; P<0.01), suggesting higher quality of recovery. The sumatriptan group also had significantly lower headache scores at 4, 12, and 24 h. There were no significant differences in other secondary outcomes.

Conclusions: Use of sumatriptan improved the quality of recovery as measured by the QoR-40 and reduction of headache at 24 h after surgery. Sumatriptan is a useful alternative treatment for postcraniotomy headache. The mechanism remains unknown but could be related to reduction in headache, mood modulation, or both, mediated by a serotonin effect.

Clinical trial registration: NCT01632657.

Keywords: analgesia; headache; microvascular decompression surgery; recovery, postoperative; sumatriptan.

© The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Figures

Fig 1

CONSORT statement: flow diagram of study participants.

Fig 2

Surgical site pain scores as measured by the numerical rating scale. Pain score is shown at 5 (a), 30 (b), 60 (c), and 120 min (d). No statistical significance was detected by Student unpaired t-test.

Fig 3

Headache scores over the first 24 h. Headache score is shown at 2 (a), 4 (b), 12 (c), and 24 h (d). The median headache scores are shown; *P < 0.05 by Student unpaired t-test.