Drug Withdrawal Headache
Conditions
Brief summary
To evaluate the association of anaesthesia and surgery with postoperative headache in elective surgery patients By multiple logistic regression analysis of data collected during a six-month period from 446 patients undergoing elective surgery, a prospective single centre cohort study in a university hospital. Participants were interviewed preoperatively and for five days postoperatively regarding the appearance of headache; while demographics, life style, type of anaesthesia and surgery, the anaesthetic drugs administered and intraoperative adverse effects in elective surgery patients are recorded.
Detailed description
A dedicated team interviewed patients preoperatively and during the first five postoperative days and collected data regarding medical history, surgery, anaesthesia and the presence of postoperative headache by manual record review. The frequency of preoperative headache was assessed by asking the subjects on the appearance or not of headache within the last year. Additional information were obtained to distinguish migraine which was deemed present only when the participants reported two or more of the following specific symptoms supporting this diagnosis as proposed by the International Headache Society; episodic headache (4-72 hours) with the following features: moderate or severe throbbing pain, worsened by movement, associated with nausea/vomiting, photophobia or phonophobia, with or without visual aura. Specifically, preoperative data included patients' demographics, marital status, life-style and habits, as caffeine consumption (\>200 mg/day or \>2 cups of coffee/day), alcohol (drink equivalent \> 15ml absolute alcohol) and tobacco consumption, previous experience or/and family history of headache. Intraoperative data included the type of anaesthesia (general, regional anaesthesia or their combination); anaesthetic drugs used; type and duration of surgery; intraoperative patients' position; and intraoperative adverse events including hypotension (decrease \>20% from baseline), hypertension (increase \>20% from baseline), hypercarbia (PaCO2 \>6 kPa) and hypoxia (SpO2 \<90%). Noticeably, the choice of anaesthetic technique and postoperative management were determined by the engaged anaesthesiologist. Postoperative headache was defined as a dichotomous variable (i.e. present or not present) by asking the participants twice daily for the first five days (or less if discharged earlier) after anaesthesia and surgery.
Interventions
None listed
Sponsors
Attikon Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* all adult patients admitted in our hospital for elective general, orthopaedic, gynaecologic, ENT(ear nose and throat) and vascular procedures
Exclusion criteria
* patient refusal * age under 18 years * cognitive dysfunction * head trauma or neurological disorders * difficulty with language comprehension or any other inability to communicate verbally with the interviewer.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Frequency of Postoperative Headache in Elective Surgery Patients | 6 months | The observed overall frequency of postoperative headache was 28.3% (N= 126) in the total sample. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Factors Associated With Postoperative Headache | 6 months | Demographic, anaesthetic and surgical factors associated with postoperative headache |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Elective Surgery Patients All adult patients admitted in our hospital for elective general, orthopaedic, gynaecologic, ear-nose-throat (ENT) and vascular procedures. | 446 |
| Total | 446 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | operated or discharged during weekend | 48 |
Baseline characteristics
| Characteristic | Elective Surgery Patients |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 50 Participants |
| Age, Categorical Between 18 and 65 years | 396 Participants |
| Age, Continuous | 42.8 years |
| Region of Enrollment Greece | 446 participants |
| Sex: Female, Male Female | 321 Participants |
| Sex: Female, Male Male | 125 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 |
Outcome results
Primary
Frequency of Postoperative Headache in Elective Surgery Patients
The observed overall frequency of postoperative headache was 28.3% (N= 126) in the total sample.
Time frame: 6 months
Population: Frequency of postoperative headache in total sample (n=446), Post-op Headache, no History of Headache (n=229), Post-op Headache, History of Headache (n=217), where n= number of participants analyzed
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Elective Surgery Patients (Total Sample) | Frequency of Postoperative Headache in Elective Surgery Patients | postoperative headache in total sample | 126 participants |
| Elective Surgery Patients (Total Sample) | Frequency of Postoperative Headache in Elective Surgery Patients | postop headache with no history of headache | 37 participants |
| Elective Surgery Patients (Total Sample) | Frequency of Postoperative Headache in Elective Surgery Patients | postop headache with previous history | 89 participants |
Secondary
Factors Associated With Postoperative Headache
Demographic, anaesthetic and surgical factors associated with postoperative headache
Time frame: 6 months
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Elective Surgery Patients (Total Sample) | Factors Associated With Postoperative Headache | sevoflurane administration | 91 participants |
| Elective Surgery Patients (Total Sample) | Factors Associated With Postoperative Headache | smoking | 79 participants |
| Elective Surgery Patients (Total Sample) | Factors Associated With Postoperative Headache | intraoperative hypotension | 98 participants |
| Elective Surgery Patients (Total Sample) | Factors Associated With Postoperative Headache | caffeine consumption | 104 participants |
| Elective Surgery Patients (Total Sample) | Factors Associated With Postoperative Headache | female gender | 103 participants |
| Postoperative Headache Patients Without Headache History | Factors Associated With Postoperative Headache | caffeine consumption | 34 participants |
| Postoperative Headache Patients Without Headache History | Factors Associated With Postoperative Headache | female gender | 32 participants |
| Postoperative Headache Patients Without Headache History | Factors Associated With Postoperative Headache | sevoflurane administration | 27 participants |
| Postoperative Headache Patients Without Headache History | Factors Associated With Postoperative Headache | intraoperative hypotension | 23 participants |
| Postoperative Headache Patients Without Headache History | Factors Associated With Postoperative Headache | smoking | 22 participants |
Comparison: Sevoflurane administration in developing postoperative headachep-value: 0.00195% CI: [2.04, 5.13]t-test, 2 sided
Comparison: Smoking as a factor for developing postoperative headachep-value: 0.00695% CI: [1.19, 2.84]t-test, 2 sided
Comparison: Intraoperative hypotension associated with postoperative headache in total samplep-value: 0.00895% CI: [1.22, 3.66]t-test, 2 sided
Comparison: Female gender as a factor for developing postoperative headachep-value: 0.02495% CI: [1.08, 3.15]t-test, 2 sided
Comparison: Association of female gender and postoperative headachep-value: 0.00595% CI: [1.58, 13.17]t-test, 2 sided
Comparison: Association of intraoperative hypotension and postoperative headachep-value: 0.00695% CI: [1.48, 9.72]t-test, 2 sided
Comparison: Association of caffeine consumption and postoperative headachep-value: 0.04195% CI: [1.06, 14.06]t-test, 2 sided
Comparison: Association of sevoflurane administration and postoperative headachep-value: 0.00195% CI: [1.82, 9.95]t-test, 2 sided