Impact of Scalp Block on Incidence of Persistent Post Craniotomy Headache: A single centre cross-sectional study

Background: Persistent post-craniotomy headache (PCH) is a significant concern in neurosurgical care, impacting patient recovery and quality of life. Despite its clinical relevance, the etiology and optimal management of PCH remain poorly understood. This study investigates the incidence and potential contributing factors of PCH and evaluates the effectiveness of scalp block as an intervention to mitigate this complication. Methods: This retrospective observational study was conducted at the University Malaya Medical Centre, including patients aged 18 years and older who underwent craniotomy between June 2018 and June 2022. Data were collected from medical records and phone interviews, focusing on demographic and clinical characteristics, history of preceding headache, and HIT-6™ scores to assess headache impact. Statistical analyses were performed to determine PCH incidence and identify significant predictive factors. Results: PCH was reported by 29.2% of the 171 patients included. A significant association was found between preceding headache (p = 0.0003, OR = 4.7) and scar tenderness (p = 0.0001, OR = 5.56) with PCH. Scalp block administration was associated with a reduced incidence of PCH, observed in only 13.3% of patients who received it compared to 42.7% without it (p = 0.045, OR = 3.13). Other factors, such as gender, age, BMI, and type of surgery, did not show significant associations. HIT-6™ scores indicated that 43.9% of patients experienced moderate to severe impact from PCH. Conclusion: The study highlights the substantial incidence of PCH and the importance of scalp block as a potential intervention to reduce its prevalence. The findings underscore the need for incorporating preoperative assessment of headache history and managing scar tenderness postoperatively. Future multicenter studies are recommended to validate these results and further refine strategies for PCH management. Clinical trial number : not applicable