Sumatriptan Improves Quality of Recovery After Craniotomy

The use of sumatriptan decreases post-operative headache at the non-surgical site in patients who undergo craniotomy for the treatment of trigeminal neuralgia and facial spasms, researchers said here at the 2015 Annual Meeting of the Canadian Anesthesiologists’ Society (CAS).

“These patients complain of pain at the non-surgical site as well as nausea and vomiting,” said Lakshmikumar Venkat Raghavan, MD, Toronto Western Hospital and the University of Toronto, Toronto, Ontario. “We find that conventional medicines like non-steroidal anti-inflammatory drugs don’t relieve the headache they experience or treat the other symptoms nausea and vomiting.”

Given the effectiveness of sumatriptan in treating migraine headaches, the investigators sought to explore its impact on treating headache after craniotomy in these patients.

The single-centre, prospective examination saw randomisation of 50 patients with 25 given placebo and 25 given subcutaneous injections of sumatriptan. The investigators used the Quality of Recovery-40, which has been used and validated in neurosurgery, to assess recovery at 24 hours post-operatively and found scores were significantly higher in the patients who received active therapy (P < .01). The median score in the sumatriptan group was 184 while the score was 139 in the placebo group.

“We found that patients who were given sumatriptan scored better on all 5 domains,” said Dr. Raghavan, noting the domains included physical comfort, emotional state, physical independence, patient support, and pain.

Patients who complain of headache and these symptoms are typically not discharged soon after surgery because of these symptoms, so effective treatment will permit earlier discharge of these patients, said Dr. Raghavan. Moreover, the headache can become chronic for some patients.

“We should treat these patients as soon as possible,” said Dr. Raghavan.

Sumatriptan is not designed to be a long-term treatment in this patient population, he noted; patients were not followed after their 24-hour assessment.

Future research will look at the impact of sumatriptan on the relief of post-treatment headache that patients who have had an aneurysm and undergo treatment experience, said Dr. Raghavan.