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

Impact of Scalp Block on Incidence of Persistent Post Craniotomy Headache: A single centre cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Scalp Block on Incidence of Persistent Post Craniotomy Headache: A single centre cross-sectional study Chun Hong Yeap, Retnagowri Rajandram, Vairavan Narayanan, Jeyaganesh Veerakumaran This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6789798/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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 Craniotomy Chronic headache HIT-6 Post craniotomy headache Scalp block Figures Figure 1 Introduction Post-craniotomy headache (PCH) is a common and significant complication in neurosurgical practice, adversely affecting patients' quality of life and recovery. Despite advances in neurosurgical techniques and postoperative care, persistent PCH remains a prevalent issue, with reported incidence rates reaching up to 60% in some studies​. ( 1 ) Approximately 25% of patients experiencing acute post-craniotomy headache develop a chronic form that persists beyond the immediate postoperative period, impacting daily functioning and overall well-being. ( 2 , 3 )​ The International Headache Society has recognized the clinical importance of PCH by classifying it as a distinct condition in its 2004 International Classification of Headache Disorders, with further refinements in the third edition (ICHD-3). This classification defines PCH as a headache persisting for more than three months post-surgery. ( 2 ) Despite these advancements in classification, the aetiology and optimal management strategies for PCH are still not fully elucidated, highlighting the need for further investigation. ( 4 , 5 ) This study seeks to address the existing knowledge gap by assessing the incidence of persistent PCH and exploring potential contributing factors. Additionally, the research aims to evaluate the effectiveness of scalp block, a technique involving local anaesthetic infiltration around the scalp nerves, as an intervention to mitigate chronic PCH. Previous studies have demonstrated that scalp block can reduce acute postoperative pain, decrease opioid consumption, and stabilize intraoperative hemodynamic parameters, making it a promising candidate for broader use in postoperative care. ( 6 , 7 , 8 ) The Headache Impact Test-6 (HIT-6™) was chosen for this study as a validated tool to measure the severity and impact of headaches on patients' lives, covering domains such as social and role functioning, vitality, cognitive functioning, psychological distress, and headache pain severity. ( 9 , 10 ) The application​ of HIT-6 provides a comprehensive assessment that helps quantify the burden of persistent PCH and supports targeted intervention strategies. ( 9 , 10 ) By identifying the incidence and underlying factors associated with PCH and assessing the utility of scalp blocks in its management, this study aims to contribute evidence-based insights to neurosurgical practice. Findings from this research could lead to enhanced patient care protocols, reduced chronic pain, and improved quality of life for patients undergoing craniotomy. Method Study Design and Population This retrospective observational study was conducted at the University Malaya Medical Centre (UMMC) and received ethical approval from the UMMC Medical Research Ethics Committee (MREC). The study included patients aged 18 years and above who underwent craniotomy at UMMC between June 2018 and June 2022. Exclusion criteria included children and patients with poor Glasgow Coma Scores (GCS ≤ 14). A total of 171 eligible patients were identified from the operating theatre registry for craniotomies performed within the specified timeframe. Figure 1 shows the flow diagram of patient recruitment and successful contact. Study Implementation and Definitions Persistent post-craniotomy headache (PCH) was defined in accordance with ICHD-3 criteria as a headache that develops within seven days following craniotomy and persists for over three months, provided it cannot be attributed to any other ICHD-3 diagnosis. The scalp block protocol at UMMC was standardized, employing Bupivacaine 0.25% with a maximum allowable dose of 2 mg/kg. A volume of 2–3 ml was administered at each of the following sites: supraorbital, supratrochlear, zygomaticotemporal, auriculotemporal, greater occipital, and lesser occipital nerves. The block was performed by a neuro-anaesthetist or a neurosurgeon prior to the surgical incision. For the purpose of this study, preceding headache was defined as any reported headache occurring within one year prior to the patient’s hospital admission and subsequent craniotomy. Scar tenderness was assessed as a reported painful sensation upon touch at the craniotomy site, as recorded during a phone interview or clinic visit. Emergency surgery was defined as craniotomies performed on an emergency basis while elective surgeries were those planned in advance during the study period. The HIT-6™ score, was used for evaluating the impact of persistent headaches six months post-surgery. This assessment was conducted via phone interviews and was limited to patients meeting the criteria for PCH. Study Outcomes Demographic and clinical characteristics, including gender, ethnicity, age, BMI, use of scalp block, surgical approach, duration of surgery, wound closure method, history of cranioplasty, repeat surgeries, wound infection, history of preceding headache, diabetes status, and scar tenderness, were collected through detailed phone interviews with patients, focusing on the presence of chronic post-craniotomy headache and their Headache Impact Test-6 (HIT-6) scores. Data Analysis Comprehensive statistical analysis was performed on the collected data to determine the incidence of persistent PCH and to identify contributing factors. Additionally, the effectiveness of the scalp block intervention was evaluated in reducing the occurrence of chronic headaches. Statistical analyses were carried out using IBM SPSS Statistics version 29 (IBM, USA). A p-value less than 0.05 was considered statistically significant. Chi-square (Χ²) test followed by univariate logistic regression as methods to determine factors that differ between 2 groups. Factors that were statistically significant in the univariate analyses were subjected to multivariate analysis to determine independent contributing factors. Results Table 1 Demographics and Clinical Characteristics Clinical Characteristics N (%) Headache N = 50 (29.2%) No Headache N = 121 (70.3%) p-value Gender 0.128 b Male 101 (59.1%) 25 (24.8%) 76 (75.2%) Female 70 (40.9%) 25 (35.7%) 45 (64.2%) Ethnicity 0.413 a Chinese 66 (38.6%) 17 (25.8%) 49 (74.2%) Malay 71 (41.5%) 25 (35.2%) 46 (64.8%) Indian 32 (18.7%) 7 (22%) 25 (78%) Other 2 (0.12%) 1 (50%) 1 (50%) Age 0.500 a < 40 73 (42.7%) 23 (31.5%) 50 (68.5%) 40–59 57 (33.3%) 18 (31.6%) 39 (68.4%) ≥ 60 41 (24%) 9 (22%) 32 (78%) BMI 0.400 a Normal 87 (50.9%) 28 (32.2%) 59 (67.8%) Underweight 12 (7%) 2 (16.7%) 10 (83.3%) Overweight 44 (25.7%) 11 (25%) 33 (75%) Obese 28 (16.4%) 9 (32.1%) 19 (67.9%) a Pearson Chi-square test; b Fisher’s exact test Based on the analysis of the demographics and clinical characteristics (Table 1 ), involving 171 patients who underwent craniotomy, post-craniotomy headache (PCH) was observed in 29.2% (n = 50) of patients, while 70.3% (n = 121) did not report such headaches. This finding underscores that PCH is a considerable postoperative complication affecting nearly one-third of the patient population. Our analysis indicated no statistically significant difference in the incidence of PCH between male and female patients (p = 0.128), ethnicity (p = 0.413), age (p = 0.500) or body mass index (p = 0.400). Table 2 Factors contributing to post craniotomy Headache Clinical Characteristics N (%) Headache N = 50 (29.2%) No Headache N = 121 (70.3%) p-value Scalp block 0.045 b * Yes (N = 30) 30 (17.5%) 4 (13.3%) 26 (86.7%) No (N = 141) 141 (82.5%) 46 (42.7%) 95 (67.3%) Surgical approach 0.17 b Supratentorial (N = 144) 144 (84%) 39 (27%) 105 (72.9) Infratentorial (N = 27) 27 (16%) 11 (40.7%) 16 (59.3%) Suture type 0.702 b Stapler (N = 44) 44 (25.7%) 14 (31.8%) 30 (68.2%) Non-Stapler (N = 127) 127 (74.3%) 36 (28.3%) 91 (71.6%) Cranioplasty 0.639 b Yes (N = 25) 25 (14.6%) 6 (24%) 19 (76%) No (N = 146) 146 (85.4%) 44 (30.1%) 102 (69.9%) Duration of Surgery 0.734 b < 2.5 (N = 73) 73 (42.7%) 20 (27.4%) 53 (72.6%) ≥ 2.5 (N = 98) 98 (57.3%) 30 (30.6%) 68 (69.4%) Second Surgery 0.129 b Yes (N = 21) 21 (12.3%) 3 (14.3%) 18 (85.7%) No (N = 150) 150 (87.7%) 47 (31.2%) 103 (68.8%) Diabetes 0.798 b Yes (N = 21) 21 (12.3%) 5 (23.8%) 16 (76.2%) No (N = 150) 150 (87.7%) 45 (30%) 105 (70%) Wound Infection 0.350 b Yes (N = 13) 13 (7.6%) 2 (13%) 11 (87%) No (N = 158) 158 (92.4%) 48 (30.4%) 110 (69.6%) Preceding Headache 0.0003 b * Yes (N = 31) 31 (18.1%) 18 (58%) 13 (42%) No (N = 140) 140 (81.9%) 32 (22.9%) 108 (77.1%) Scar tenderness 0.0001 b * Yes (N = 29) 29 (17%) 18 (62%) 11 (38%) No (N = 142) 142 (83%) 32 (22.5%) 110 (77.5%) Elective vs emergency 0.854 b Elective 120 (70.2%) 36 (30%) 84 (70%) Emergency 51 (29.8%) 14 (28%) 37 (72%) a Pearson Chi-square test; b Fisher’s exact test Table 2 outlines the various factors contributing to the development of post-operative headaches in patients undergoing craniotomy. The administration of scalp block, presence of preceding headache and scar tenderness were the only significant factor to be identified and were subjected to further univariate and multivariate analysis. Other factors studied including BMI, age, duration of surgery, cranioplasty, repeat surgery, and diabetes status showed no significant associations with PCH, as reflected by their p-values exceeding the 0.05 threshold. This suggests that these factors may not play a pivotal role in the development of persistent headaches post-craniotomy. Similarly, the type of surgical approach (supratentorial or infratentorial) did not show a significant relationship with PCH occurrence (p = 0.17). However, patients undergoing infratentorial procedures had a higher observed incidence of PCH (40.7%) compared to those who had supratentorial surgeries (27%), indicating a potential trend that warrants further investigation. Table 3 Univariate and Multivariate Analysis of Factors affecting post operative Headache Characteristic No Headache (n) Headache (n) Univariate OR (Headache) 95% CI for Univariate OR Univariate p-value Multivariate OR (Headache) 95% CI for Multivariate OR Multivariate p-value Scalp Block No 95 46 3.13 1.00–13.13 0.045 3.13 1.00–13.13 0.045 Yes 26 4 Reference Reference Preceding Headache Yes 13 18 4.7 1.91–11.50 0.0003 4.7 1.91–11.50 0.0003 No 108 32 Reference Reference Scar Tenderness Yes 11 17 5.56 2.23–14.48 0.0001 5.56 2.23–14.48 0.0001 No 110 33 Reference Reference The univariate and multivariate analyses (Table 3 ) reveal several significant factors affecting the incidence of post-operative headaches. The administration of a scalp block was significantly associated with reduced incidence of PCH. Patients who did not receive a scalp block were found to have higher odds of developing PCH compared to those who did (Univariate and Multivariate OR: 3.13, 95% CI: 1.00–13.13, p = 0.045). A history of headaches within one year prior to the craniotomy was a strong predictor of PCH. Patients with preceding headaches had significantly higher odds of developing PCH than those without such a history (Univariate and Multivariate OR: 4.7, 95% CI: 1.91–11.50, p = 0.0003). Scar tenderness was identified as the most significant predictor of PCH. Patients reporting scar tenderness had markedly increased odds of experiencing PCH compared to those without tenderness (Univariate and Multivariate OR: 5.56, 95% CI: 2.23–14.48, p = 0.0001). These findings emphasize the need for postoperative management strategies that address scar-related discomfort to potentially reduce PCH incidence. Table 4 Headache Impact Test (HIT-6™) Score Distribution HIT-6™ Score Category Number of Subjects Little to No Impact (≤ 49) 23 (56.1%) Some Impact (50–55) 6 (14.6%) Substantial Impact (56–59) 6 (14.6%) Very Severe Impact (≥ 60) 6 (14.6%) #9 subjects did not have HIT-6 score as they were either unable to describe their headache symptoms or had no pain at the time of interview The HIT-6™ scores were used to evaluate the impact of PCH on patients' daily lives. The distribution of scores (Table 4 ) indicated that 43.9% of patients with PCH reported experiencing some degree of impact reflecting a moderate to considerable interference with their daily quality of life. Discussion The findings of this study underscore the prevalence and clinical relevance of persistent post-craniotomy headache (PCH), affecting nearly one-third of patients undergoing craniotomy at our centre. This high incidence is consistent with reports in the literature, where PCH prevalence can reach up to 60%​. ( 1 , 2 ) Despite advances in surgical and postoperative practices, PCH remains a significant complication that adversely impacts patient recovery and quality of life ( 2 , 3 , 9 , 10 ) Our study's exploration of potential predictive factors and the evaluation of scalp block intervention offer valuable insights for clinical practice. One of the most significant findings from this study was the protective effect of scalp block in reducing PCH incidence. Patients who did not receive a scalp block were more than three times as likely to experience PCH compared to those who received this intervention (OR: 3.13, p = 0.045). The effectiveness of scalp block in minimizing postoperative pain and reducing opioid use has been documented in prior studies, suggesting that its routine use could be a beneficial addition to pain management protocols in neurosurgical practice. ( 11 , 12 , 13 , 14 , 15 , 16 ) This finding supports the integration of scalp blocks into standard surgical procedures to enhance patient outcomes. The study also highlighted the importance of preoperative assessment for a history of headaches. Patients with preceding headaches had significantly higher odds of developing PCH (OR: 4.7, p = 0.0003). This suggests that a comprehensive preoperative evaluation, including headache history, could be an essential step in identifying patients at higher risk for persistent postoperative pain. Addressing such risks preemptively through targeted interventions could potentially reduce the burden of chronic headaches post-surgery. ( 17 ) Scar tenderness emerged as the strongest predictor of PCH in our cohort, with an odds ratio of 5.56 (p = 0.0001). This finding aligns with the understanding that surgical site sensitivity can influence postoperative pain experiences. Managing scar tenderness through post-surgical interventions, such as localized pain therapy or physiotherapy, may contribute to mitigating PCH and improving overall patient comfort​. ( 3 , 17 , 18 , 19 , 20 , 21 ) This aspect warrants further research to develop specific guidelines for postoperative scar management in craniotomy patients. Interestingly, other variables such as gender, surgical approach, BMI, and duration of surgery did not show significant associations with PCH. Although previous studies have reported mixed results regarding these factors, our findings suggest that they may not be primary considerations in PCH risk assessment. ( 22 , 23 , 24 , 25 ) The higher, albeit non-significant, incidence of PCH in patients undergoing infratentorial surgeries (40.7%) compared to supratentorial procedures (27%) points to a possible trend that could be explored in larger, multicenter studies. ( 25 , 26 , 27 ) The impact of PCH on patients' quality of life, as measured by the HIT-6™ scores, highlighted that a significant subset of patients suffered from moderate to severe headaches. Notably, 14.6% of patients reported "very severe impact" scores, which emphasize the need for comprehensive pain management strategies post-craniotomy. These findings advocate for targeted pain management plans that not only address immediate postoperative pain but also provide ongoing support for patients at risk of chronic headache​. Implementing such strategies could lead to better long-term patient outcomes and reduced healthcare burdens. ( 28 , 29 , 30 ) This study highlights the significant potential of scalp blocks and personalized pain management strategies in improving post-craniotomy headache (PCH) outcomes, aligning with the current focus on patient-centred care and precision medicine. Tailored interventions could better address individual risk factors for PCH, while further research into the neurophysiological effects of scalp blocks could deepen understanding of their analgesic mechanisms. To strengthen these findings, larger multicenter trials are needed to standardize scalp block protocols and enhance generalizability. Additionally, examining genetic predispositions and surgical variations may provide a broader perspective on PCH etiology and inform targeted prevention strategies. ( 31 ) Complementary therapies, such as physical therapy and acupuncture, should also be considered as adjuncts to conventional approaches, contributing to comprehensive care plans that reduce PCH incidence and improve patient quality of life. ( 32 , 33 ) Limitations and Future Directions This study has several limitations that should be acknowledged. Its retrospective design and reliance on patient-reported outcomes may introduce recall bias and data inaccuracies. Conducted at a single centre, the findings may lack generalizability to other institutions with different practices. The sample size, while adequate for primary analysis, may not capture less common associations, and potential confounding factors could remain unaccounted for. Additionally, variability in scalp block administration and the focus on a single six-month follow-up limit the understanding of long-term outcomes. Future multicenter, future prospective longitudinal research with larger sample sizes is needed to validate these findings and enhance the management of PCH. Conclusion In conclusion, this study reinforces the importance of scalp block as an effective intervention to reduce the incidence of PCH. It also identifies preceding headache and scar tenderness as significant predictive factors, which should be incorporated into risk stratification and postoperative care protocols. Future research should focus on refining predictive models, exploring additional pain management strategies, and validating these findings in larger, diverse populations to enhance clinical practice. Declarations Ethic Approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki and received ethical approval from the UMMC Medical Research Ethics Committee (MREC), MECID.No 2021830-10528. Informed consent is obtained from all patients as per ethical approval guidelines. Consent for publication The authors confirm that informed consent has been obtained from all participants involved in the study. Additionally, the authors have received approval from the institutional ethics committee for the publication of this manuscript. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request and permission of UMMC Medical Research Ethics Committee Conflicts of Interest/ Competing Interest All Authors declared no potential conflicts of interest with respect to research, authorship, and/or publication of this article. Funding No financial support was received for the research, authorship and/or publication of this article. Clinical trial number Not applicable. Authors’ Contribution Yeap Chun Hong = YCH; Retnagowri Rajandram = RR; Vairavan Narayanan = VN and Jeyaganesh Veerakumaran= JV YCH: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration; Resources, Software, Visualization and Writing – original draft. RR: Conceptualization, Data curation; Formal analysis, Methodology; Resources; Software; Validation; Visualization; Writing – original draft and Writing – review & editing. VN: Conceptualization, Data curation, Formal analysis, Methodology; Supervision; Validation and Writing – review & editing. JV: Conceptualization, Data curation, Methodology, Project administration, Resources; Supervision, Validation and Writing – review & editing Acknowledgement The authors acknowledge the support of the Department of Anaesthesiology and the Department of Surgery, Faculty of Medicine, Universiti Malaya, throughout the research process. Their guidance and resources were invaluable to this study. References De Benedittis, S., Lorenzetti, A., Migliore, M., Spagnoli, D., Tiberio, F., & Villani, R. M. (1996). Postoperative pain in Neurosurgery: A pilot study in brain surgery. 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National trends in direct health care expenditures among US adults with migraine: 2004 to 2013. Journal of Pain, 18(1), 96–107. https://doi.org/10.1016/j.jpain.2016.10.005 Shaffrey, E. C., Seitz, A. J., Albano, N. J., Israel, J. S., & Afifi, A. M. (2023). Expanding our role in headache management. Annals of Plastic Surgery, 91(2), 245–256. https://doi.org/10.1097/sap.0000000000003636 Grangeon, L., Lange, K. S., Waliszewska-Prosół, M., Onan, D., Marschollek, K., Wiels, W., Mikulenka, P., Farham, F., Gollion, C., & Ducros, A. (2023). Genetics of migraine: where are we now? The Journal of Headache and Pain, 24(1). https://doi.org/10.1186/s10194-023-01547-8 Liu, X., Li, S., Wang, B., An, L., Ren, X., & Wu, H. (2015). Intraoperative and Postoperative Anaesthetic and Analgesic Effect of Multipoint Transcutaneous Electrical Acupuncture Stimulation Combined with Sufentanil Anaesthesia in Patients Undergoing Supratentorial Craniotomy. Acupuncture in Medicine, 33(4), 270–276. https://doi.org/10.1136/acupmed-2014-010749 Lv, J., Li, P., Zhou, L., Tang, W., & Li, N. (2021). Acupuncture at the P6 Acupoint to Prevent Postoperative Pain after Craniotomy: A Randomized, Placebo-Controlled Study. Evidence-based Complementary and Alternative Medicine, 2021, 1–8. https://doi.org/10.1155/2021/6619855 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6789798","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":484502102,"identity":"1f331600-73b4-48e1-9ab9-5528fa1da931","order_by":0,"name":"Chun Hong Yeap","email":"","orcid":"","institution":"Universiti Malaya","correspondingAuthor":false,"prefix":"","firstName":"Chun","middleName":"Hong","lastName":"Yeap","suffix":""},{"id":484502104,"identity":"74814c06-1c73-4415-bc2a-e0176d5a29a6","order_by":1,"name":"Retnagowri Rajandram","email":"","orcid":"","institution":"Universiti Malaya","correspondingAuthor":false,"prefix":"","firstName":"Retnagowri","middleName":"","lastName":"Rajandram","suffix":""},{"id":484502105,"identity":"b8892e39-45a6-4cd4-8411-cc097222d3be","order_by":2,"name":"Vairavan Narayanan","email":"","orcid":"","institution":"Universiti Malaya","correspondingAuthor":false,"prefix":"","firstName":"Vairavan","middleName":"","lastName":"Narayanan","suffix":""},{"id":484502106,"identity":"2ac5b207-0201-40af-a829-3d087f5f7298","order_by":3,"name":"Jeyaganesh Veerakumaran","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYFCCA2AygR9MsZGiRbKBeC0QkGBwgFgtBgePX/xcUFGXZ3wjO4HhQ9lhBt0ZCQS0HDhTLD3jzOFisxu5GxhnnDvMYHaDgBbJhjMJ0rxtBxK3AbUw87YRpyX5N++/usTNM4Ba/hKjhZ/h+DFp3gbmxA0SQC2MxGk5w2bNc+xw4owzbzcc7DmXzmN25gF+LWwSxx/f5qmpS+xvz9344EeZtZzZcQK2MEicMYCzDwAxD4MAIS387eju4D9AQMsoGAWjYBSMNAAA+C1N2pCLHl8AAAAASUVORK5CYII=","orcid":"","institution":"Universiti Malaya","correspondingAuthor":true,"prefix":"","firstName":"Jeyaganesh","middleName":"","lastName":"Veerakumaran","suffix":""}],"badges":[],"createdAt":"2025-05-31 08:53:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6789798/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6789798/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86671276,"identity":"5e7cff9b-c54b-44c5-9a43-027ece9888f8","added_by":"auto","created_at":"2025-07-14 11:36:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":23654,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePATIENT RECRUITMENT\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6789798/v1/b5a8d815a9d63b6b61ab8b2c.png"},{"id":87473565,"identity":"30e3d71e-7d13-480d-81a5-da493c8d2dff","added_by":"auto","created_at":"2025-07-24 08:42:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1129021,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6789798/v1/90e45cfa-6a1d-4a8d-b180-0b0d4519ae80.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Scalp Block on Incidence of Persistent Post Craniotomy Headache: A single centre cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePost-craniotomy headache (PCH) is a common and significant complication in neurosurgical practice, adversely affecting patients' quality of life and recovery. Despite advances in neurosurgical techniques and postoperative care, persistent PCH remains a prevalent issue, with reported incidence rates reaching up to 60% in some studies​. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Approximately 25% of patients experiencing acute post-craniotomy headache develop a chronic form that persists beyond the immediate postoperative period, impacting daily functioning and overall well-being. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)​\u003c/p\u003e\u003cp\u003eThe International Headache Society has recognized the clinical importance of PCH by classifying it as a distinct condition in its 2004 International Classification of Headache Disorders, with further refinements in the third edition (ICHD-3). This classification defines PCH as a headache persisting for more than three months post-surgery. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Despite these advancements in classification, the aetiology and optimal management strategies for PCH are still not fully elucidated, highlighting the need for further investigation. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThis study seeks to address the existing knowledge gap by assessing the incidence of persistent PCH and exploring potential contributing factors. Additionally, the research aims to evaluate the effectiveness of scalp block, a technique involving local anaesthetic infiltration around the scalp nerves, as an intervention to mitigate chronic PCH. Previous studies have demonstrated that scalp block can reduce acute postoperative pain, decrease opioid consumption, and stabilize intraoperative hemodynamic parameters, making it a promising candidate for broader use in postoperative care. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThe Headache Impact Test-6 (HIT-6\u0026trade;) was chosen for this study as a validated tool to measure the severity and impact of headaches on patients' lives, covering domains such as social and role functioning, vitality, cognitive functioning, psychological distress, and headache pain severity. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) The application​ of HIT-6 provides a comprehensive assessment that helps quantify the burden of persistent PCH and supports targeted intervention strategies. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eBy identifying the incidence and underlying factors associated with PCH and assessing the utility of scalp blocks in its management, this study aims to contribute evidence-based insights to neurosurgical practice. Findings from this research could lead to enhanced patient care protocols, reduced chronic pain, and improved quality of life for patients undergoing craniotomy.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Population\u003c/h2\u003e\u003cp\u003e This retrospective observational study was conducted at the University Malaya Medical Centre (UMMC) and received ethical approval from the UMMC Medical Research Ethics Committee (MREC). The study included patients aged 18 years and above who underwent craniotomy at UMMC between June 2018 and June 2022. Exclusion criteria included children and patients with poor Glasgow Coma Scores (GCS\u0026thinsp;\u0026le;\u0026thinsp;14). A total of 171 eligible patients were identified from the operating theatre registry for craniotomies performed within the specified timeframe. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the flow diagram of patient recruitment and successful contact.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Implementation and Definitions\u003c/h3\u003e\n\u003cp\u003ePersistent post-craniotomy headache (PCH) was defined in accordance with ICHD-3 criteria as a headache that develops within seven days following craniotomy and persists for over three months, provided it cannot be attributed to any other ICHD-3 diagnosis.\u003c/p\u003e\u003cp\u003eThe scalp block protocol at UMMC was standardized, employing Bupivacaine 0.25% with a maximum allowable dose of 2 mg/kg. A volume of 2\u0026ndash;3 ml was administered at each of the following sites: supraorbital, supratrochlear, zygomaticotemporal, auriculotemporal, greater occipital, and lesser occipital nerves. The block was performed by a neuro-anaesthetist or a neurosurgeon prior to the surgical incision.\u003c/p\u003e\u003cp\u003eFor the purpose of this study, preceding headache was defined as any reported headache occurring within one year prior to the patient\u0026rsquo;s hospital admission and subsequent craniotomy. Scar tenderness was assessed as a reported painful sensation upon touch at the craniotomy site, as recorded during a phone interview or clinic visit. Emergency surgery was defined as craniotomies performed on an emergency basis while elective surgeries were those planned in advance during the study period. The HIT-6\u0026trade; score, was used for evaluating the impact of persistent headaches six months post-surgery. This assessment was conducted via phone interviews and was limited to patients meeting the criteria for PCH.\u003c/p\u003e\n\u003ch3\u003eStudy Outcomes\u003c/h3\u003e\n\u003cp\u003eDemographic and clinical characteristics, including gender, ethnicity, age, BMI, use of scalp block, surgical approach, duration of surgery, wound closure method, history of cranioplasty, repeat surgeries, wound infection, history of preceding headache, diabetes status, and scar tenderness, were collected through detailed phone interviews with patients, focusing on the presence of chronic post-craniotomy headache and their Headache Impact Test-6 (HIT-6) scores.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eComprehensive statistical analysis was performed on the collected data to determine the incidence of persistent PCH and to identify contributing factors. Additionally, the effectiveness of the scalp block intervention was evaluated in reducing the occurrence of chronic headaches.\u003c/p\u003e\u003cp\u003eStatistical analyses were carried out using IBM SPSS Statistics version 29 (IBM, USA). A p-value less than 0.05 was considered statistically significant. Chi-square (Χ\u0026sup2;) test followed by univariate logistic regression as methods to determine factors that differ between 2 groups. Factors that were statistically significant in the univariate analyses were subjected to multivariate analysis to determine independent contributing factors.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographics and Clinical Characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical Characteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHeadache\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;50 (29.2%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo Headache\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;121 (70.3%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.128\u003csub\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e101 (59.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (24.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e76 (75.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70 (40.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (35.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45 (64.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.413\u003csub\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChinese\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e66 (38.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (25.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49 (74.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMalay\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71 (41.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (35.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46 (64.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (18.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (22%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25 (78%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (0.12%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.500\u003csub\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73 (42.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (31.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50 (68.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e40\u0026ndash;59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57 (33.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (31.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39 (68.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (24%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (22%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32 (78%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.400\u003csub\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87 (50.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28 (32.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59 (67.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnderweight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (16.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10 (83.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverweight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44 (25.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (25%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33 (75%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObese\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (16.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (32.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19 (67.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csub\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sub\u003e \u003cb\u003ePearson Chi-square test;\u003c/b\u003e \u003csub\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sub\u003e \u003cb\u003eFisher\u0026rsquo;s exact test\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eBased on the analysis of the demographics and clinical characteristics (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), involving 171 patients who underwent craniotomy, post-craniotomy headache (PCH) was observed in 29.2% (n\u0026thinsp;=\u0026thinsp;50) of patients, while 70.3% (n\u0026thinsp;=\u0026thinsp;121) did not report such headaches. This finding underscores that PCH is a considerable postoperative complication affecting nearly one-third of the patient population. Our analysis indicated no statistically significant difference in the incidence of PCH between male and female patients (p\u0026thinsp;=\u0026thinsp;0.128), ethnicity (p\u0026thinsp;=\u0026thinsp;0.413), age (p\u0026thinsp;=\u0026thinsp;0.500) or body mass index (p\u0026thinsp;=\u0026thinsp;0.400).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFactors contributing to post craniotomy Headache\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical Characteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHeadache\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;50 (29.2%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo Headache\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;121 (70.3%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eScalp block\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.045\u003csub\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes (N\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 (17.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (13.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26 (86.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo (N\u0026thinsp;=\u0026thinsp;141)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e141 (82.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46 (42.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95 (67.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSurgical approach\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.17\u003csub\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSupratentorial (N\u0026thinsp;=\u0026thinsp;144)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e144 (84%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39 (27%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e105 (72.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInfratentorial (N\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 (16%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (40.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (59.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSuture type\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.702\u003csub\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStapler (N\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44 (25.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (31.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30 (68.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-Stapler (N\u0026thinsp;=\u0026thinsp;127)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e127 (74.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36 (28.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e91 (71.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCranioplasty\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.639\u003csub\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes (N\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 (14.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (24%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19 (76%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo (N\u0026thinsp;=\u0026thinsp;146)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e146 (85.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44 (30.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e102 (69.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDuration of Surgery\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.734\u003csub\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;2.5 (N\u0026thinsp;=\u0026thinsp;73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73 (42.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 (27.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e53 (72.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;2.5 (N\u0026thinsp;=\u0026thinsp;98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e98 (57.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (30.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68 (69.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSecond Surgery\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.129\u003csub\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes (N\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (12.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (14.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18 (85.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo (N\u0026thinsp;=\u0026thinsp;150)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e150 (87.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47 (31.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e103 (68.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiabetes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.798\u003csub\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes (N\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (12.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (23.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (76.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo (N\u0026thinsp;=\u0026thinsp;150)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e150 (87.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45 (30%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e105 (70%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWound Infection\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.350\u003csub\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes (N\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (7.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (13%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11 (87%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo (N\u0026thinsp;=\u0026thinsp;158)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e158 (92.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48 (30.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e110 (69.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePreceding Headache\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.0003\u003c/b\u003e\u003csub\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sub\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes (N\u0026thinsp;=\u0026thinsp;31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31 (18.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (58%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13 (42%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo (N\u0026thinsp;=\u0026thinsp;140)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e140 (81.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32 (22.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e108 (77.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eScar tenderness\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.0001\u003c/b\u003e\u003csub\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sub\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes (N\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29 (17%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (62%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11 (38%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo (N\u0026thinsp;=\u0026thinsp;142)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e142 (83%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32 (22.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e110 (77.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eElective vs emergency\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.854\u003csub\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sub\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElective\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e120 (70.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36 (30%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84 (70%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51 (29.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (28%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37 (72%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csub\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sub\u003e \u003cb\u003ePearson Chi-square test;\u003c/b\u003e \u003csub\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sub\u003e \u003cb\u003eFisher\u0026rsquo;s exact test\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e outlines the various factors contributing to the development of post-operative headaches in patients undergoing craniotomy. The administration of scalp block, presence of preceding headache and scar tenderness were the only significant factor to be identified and were subjected to further univariate and multivariate analysis. Other factors studied including BMI, age, duration of surgery, cranioplasty, repeat surgery, and diabetes status showed no significant associations with PCH, as reflected by their p-values exceeding the 0.05 threshold. This suggests that these factors may not play a pivotal role in the development of persistent headaches post-craniotomy. Similarly, the type of surgical approach (supratentorial or infratentorial) did not show a significant relationship with PCH occurrence (p\u0026thinsp;=\u0026thinsp;0.17). However, patients undergoing infratentorial procedures had a higher observed incidence of PCH (40.7%) compared to those who had supratentorial surgeries (27%), indicating a potential trend that warrants further investigation.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eUnivariate and Multivariate Analysis of Factors affecting post operative Headache\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo Headache (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHeadache (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUnivariate OR (Headache)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e95% CI for Univariate OR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUnivariate p-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMultivariate OR (Headache)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e95% CI for Multivariate OR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eMultivariate p-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eScalp Block\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.00\u0026ndash;13.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.045\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.00\u0026ndash;13.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.045\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePreceding Headache\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.91\u0026ndash;11.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.0003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.91\u0026ndash;11.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.0003\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eScar Tenderness\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.23\u0026ndash;14.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.0001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e2.23\u0026ndash;14.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe univariate and multivariate analyses (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) reveal several significant factors affecting the incidence of post-operative headaches. The administration of a scalp block was significantly associated with reduced incidence of PCH. Patients who did not receive a scalp block were found to have higher odds of developing PCH compared to those who did (Univariate and Multivariate OR: 3.13, 95% CI: 1.00\u0026ndash;13.13, p\u0026thinsp;=\u0026thinsp;0.045).\u003c/p\u003e\u003cp\u003eA history of headaches within one year prior to the craniotomy was a strong predictor of PCH. Patients with preceding headaches had significantly higher odds of developing PCH than those without such a history (Univariate and Multivariate OR: 4.7, 95% CI: 1.91\u0026ndash;11.50, p\u0026thinsp;=\u0026thinsp;0.0003).\u003c/p\u003e\u003cp\u003eScar tenderness was identified as the most significant predictor of PCH. Patients reporting scar tenderness had markedly increased odds of experiencing PCH compared to those without tenderness (Univariate and Multivariate OR: 5.56, 95% CI: 2.23\u0026ndash;14.48, p\u0026thinsp;=\u0026thinsp;0.0001). These findings emphasize the need for postoperative management strategies that address scar-related discomfort to potentially reduce PCH incidence.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eHeadache Impact Test (HIT-6\u0026trade;) Score Distribution\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHIT-6\u0026trade; Score Category\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of Subjects\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLittle to No Impact (\u0026le;\u0026thinsp;49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23 (56.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSome Impact (50\u0026ndash;55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6 (14.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubstantial Impact (56\u0026ndash;59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6 (14.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVery Severe Impact (\u0026ge;\u0026thinsp;60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6 (14.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e#9 subjects did not have HIT-6 score as they were either unable to describe their headache symptoms or had no pain at the time of interview\u003c/p\u003e\u003cp\u003eThe HIT-6\u0026trade; scores were used to evaluate the impact of PCH on patients' daily lives. The distribution of scores (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) indicated that 43.9% of patients with PCH reported experiencing some degree of impact reflecting a moderate to considerable interference with their daily quality of life.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this study underscore the prevalence and clinical relevance of persistent post-craniotomy headache (PCH), affecting nearly one-third of patients undergoing craniotomy at our centre. This high incidence is consistent with reports in the literature, where PCH prevalence can reach up to 60%​. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Despite advances in surgical and postoperative practices, PCH remains a significant complication that adversely impacts patient recovery and quality of life (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) Our study's exploration of potential predictive factors and the evaluation of scalp block intervention offer valuable insights for clinical practice.\u003c/p\u003e\u003cp\u003eOne of the most significant findings from this study was the protective effect of scalp block in reducing PCH incidence. Patients who did not receive a scalp block were more than three times as likely to experience PCH compared to those who received this intervention (OR: 3.13, p\u0026thinsp;=\u0026thinsp;0.045). The effectiveness of scalp block in minimizing postoperative pain and reducing opioid use has been documented in prior studies, suggesting that its routine use could be a beneficial addition to pain management protocols in neurosurgical practice. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) This finding supports the integration of scalp blocks into standard surgical procedures to enhance patient outcomes.\u003c/p\u003e\u003cp\u003eThe study also highlighted the importance of preoperative assessment for a history of headaches. Patients with preceding headaches had significantly higher odds of developing PCH (OR: 4.7, p\u0026thinsp;=\u0026thinsp;0.0003). This suggests that a comprehensive preoperative evaluation, including headache history, could be an essential step in identifying patients at higher risk for persistent postoperative pain. Addressing such risks preemptively through targeted interventions could potentially reduce the burden of chronic headaches post-surgery. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eScar tenderness emerged as the strongest predictor of PCH in our cohort, with an odds ratio of 5.56 (p\u0026thinsp;=\u0026thinsp;0.0001). This finding aligns with the understanding that surgical site sensitivity can influence postoperative pain experiences. Managing scar tenderness through post-surgical interventions, such as localized pain therapy or physiotherapy, may contribute to mitigating PCH and improving overall patient comfort​. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) This aspect warrants further research to develop specific guidelines for postoperative scar management in craniotomy patients.\u003c/p\u003e\u003cp\u003eInterestingly, other variables such as gender, surgical approach, BMI, and duration of surgery did not show significant associations with PCH. Although previous studies have reported mixed results regarding these factors, our findings suggest that they may not be primary considerations in PCH risk assessment. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) The higher, albeit non-significant, incidence of PCH in patients undergoing infratentorial surgeries (40.7%) compared to supratentorial procedures (27%) points to a possible trend that could be explored in larger, multicenter studies. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThe impact of PCH on patients' quality of life, as measured by the HIT-6\u0026trade; scores, highlighted that a significant subset of patients suffered from moderate to severe headaches. Notably, 14.6% of patients reported \"very severe impact\" scores, which emphasize the need for comprehensive pain management strategies post-craniotomy. These findings advocate for targeted pain management plans that not only address immediate postoperative pain but also provide ongoing support for patients at risk of chronic headache​. Implementing such strategies could lead to better long-term patient outcomes and reduced healthcare burdens. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThis study highlights the significant potential of scalp blocks and personalized pain management strategies in improving post-craniotomy headache (PCH) outcomes, aligning with the current focus on patient-centred care and precision medicine. Tailored interventions could better address individual risk factors for PCH, while further research into the neurophysiological effects of scalp blocks could deepen understanding of their analgesic mechanisms. To strengthen these findings, larger multicenter trials are needed to standardize scalp block protocols and enhance generalizability. Additionally, examining genetic predispositions and surgical variations may provide a broader perspective on PCH etiology and inform targeted prevention strategies. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) Complementary therapies, such as physical therapy and acupuncture, should also be considered as adjuncts to conventional approaches, contributing to comprehensive care plans that reduce PCH incidence and improve patient quality of life. (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e)\u003c/p\u003e\n\u003ch3\u003eLimitations and Future Directions\u003c/h3\u003e\n\u003cp\u003eThis study has several limitations that should be acknowledged. Its retrospective design and reliance on patient-reported outcomes may introduce recall bias and data inaccuracies. Conducted at a single centre, the findings may lack generalizability to other institutions with different practices. The sample size, while adequate for primary analysis, may not capture less common associations, and potential confounding factors could remain unaccounted for. Additionally, variability in scalp block administration and the focus on a single six-month follow-up limit the understanding of long-term outcomes. Future multicenter, future prospective longitudinal research with larger sample sizes is needed to validate these findings and enhance the management of PCH.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this study reinforces the importance of scalp block as an effective intervention to reduce the incidence of PCH. It also identifies preceding headache and scar tenderness as significant predictive factors, which should be incorporated into risk stratification and postoperative care protocols. Future research should focus on refining predictive models, exploring additional pain management strategies, and validating these findings in larger, diverse populations to enhance clinical practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthic Approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki and received ethical approval from the UMMC Medical Research Ethics Committee (MREC),\u0026nbsp;MECID.No\u0026nbsp;2021830-10528. Informed consent is obtained from all patients as per ethical approval guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors confirm that informed consent has been obtained from all participants involved in the study. Additionally, the authors have received approval from the institutional ethics committee for the publication of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request and permission of UMMC Medical Research Ethics Committee\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest/ Competing Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll Authors declared no potential conflicts of interest with respect to research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo financial support was received for the research, authorship and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYeap Chun Hong = YCH; Retnagowri Rajandram = RR; Vairavan Narayanan = VN and\u0026nbsp;Jeyaganesh Veerakumaran= JV\u003c/p\u003e\n\u003cp\u003eYCH: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration; Resources, Software, Visualization and Writing – original draft. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRR: Conceptualization, Data curation; Formal analysis, Methodology; Resources; Software; Validation; Visualization; Writing – original draft and Writing – review \u0026amp; editing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVN: Conceptualization, Data curation, Formal analysis, Methodology; Supervision; Validation and Writing – review \u0026amp; editing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJV: Conceptualization, Data curation, Methodology, Project administration, Resources; Supervision, Validation and Writing – review\u0026nbsp;\u0026amp;\u0026nbsp;editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge the support of the Department of Anaesthesiology and the Department of Surgery, Faculty of Medicine, Universiti Malaya, throughout the research process. Their guidance and resources were invaluable to this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDe Benedittis, S., Lorenzetti, A., Migliore, M., Spagnoli, D., Tiberio, F., \u0026amp; Villani, R. M. (1996). Postoperative pain in Neurosurgery: A pilot study in brain surgery. Neurosurgery, 38(3), 466\u0026ndash;470. https://doi.org/10.1097/00006123-199603000-00008\u003c/li\u003e\n\u003cli\u003eThe International Classification of Headache Disorders, 3rd Edition. Headache classification committee of the International Headache Society. Cephalalgia 2018, 38(1), 1-211\u003c/li\u003e\n\u003cli\u003eRocha-Filho, P., Gherpelli, J., De Siqueira, J., \u0026amp; Rabello, G. (2007). Post-Craniotomy headache: Characteristics, behaviour and effect on quality of life in patients operated for treatment of supratentorial intracranial aneurysms. 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(2021). A randomized control trial on comparative effect of scalp nerve block using levobupivacaine versus fentanyl on the attenuation of pain and hemodynamic response to pin fixation. Bali Journal of Anesthesiology, 5(2), 66. https://doi.org/10.4103/bjoa.bjoa_183_20\u003c/li\u003e\n\u003cli\u003ePatel, K. S., Sun, M. Z., Willis, S. L., Alemnew, M., De Jong, R., Evans, A. S., Duong, C., Gopen, Q., \u0026amp; Yang, I. (2021). Selective scalp block decreases short term post-operative pain scores and opioid use after craniotomy: A case series. Journal of Clinical Neuroscience, 93, 183\u0026ndash;187. https://doi.org/10.1016/j.jocn.2021.09.010\u003c/li\u003e\n\u003cli\u003eSamagh, N., Jangra, K., \u0026amp; Dey, A. (2023). Post-craniotomy pain: an update. Journal of Neuroanaesthesiology and Critical Care, 10(01), 021\u0026ndash;030. https://doi.org/10.1055/s-0042-1760271\u003c/li\u003e\n\u003cli\u003eRigamonti, A., Garavaglia, M. M., Ma, K., Crescini, C., Mistry, N., Thorpe, K., Cusimano, M. D., Das, S., Hare, G. M. T., \u0026amp; Mazer, C. D. (2019). Effect of bilateral scalp nerve blocks on postoperative pain and discharge times in patients undergoing supratentorial craniotomy and general anesthesia: a randomized-controlled trial. Canadian Journal of Anesthesia/Journal Canadien D Anesth\u0026eacute;sie, 67(4), 452\u0026ndash;461. https://doi.org/10.1007/s12630-019-01558-7\u003c/li\u003e\n\u003cli\u003eSkutulienė, J., Banevičius, G., Bilskienė, D., \u0026amp; Macas, A. (2021). The effect of scalp block or local wound infiltration versus systemic analgesia on post-craniotomy pain relief. Acta Neurochirurgica, 164(5), 1375\u0026ndash;1379. https://doi.org/10.1007/s00701-021-04886-0\u003c/li\u003e\n\u003cli\u003eNing, L., Jiang, L., Zhang, Q., Luo, M., Xu, D., \u0026amp; Peng, Y. (2022). Effect of scalp nerve block with ropivacaine on postoperative pain in pediatric patients undergoing craniotomy: A randomized controlled trial. Frontiers in Medicine, 9. https://doi.org/10.3389/fmed.2022.952064\u003c/li\u003e\n\u003cli\u003eSubbarao, B. S., Thomas, R. J. F., Das, J. M., \u0026amp; Eapen, B. C. (2024, January 30). Postcraniotomy headache. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK482297.\u003c/li\u003e\n\u003cli\u003eKim, J., Han, S., Kwon, Y., Lee, J., \u0026amp; Sohn, J. (2024). Influence of age and sex on Post-Craniotomy headache. Biomedicines, 12(8), 1745. https://doi.org/10.3390/biomedicines12081745\u003c/li\u003e\n\u003cli\u003eFortini, I., \u0026amp; Felsenfeld, B. D., Junior. (2022). Headaches and obesity. Arquivos De Neuro-Psiquiatria, 80(5 suppl 1), 204\u0026ndash;213. https://doi.org/10.1590/0004-282x-anp-2022-s106 \u003c/li\u003e\n\u003cli\u003eShibata, Y., Hatayama, T., Matsuda, M., Yamazaki, T., Komatsu, Y., Endo, K., \u0026amp; Akutsu, H. (2022b). Epidemiology of post-suboccipital craniotomy headache: A multicentre retrospective study. Journal of Perioperative Practice, 33(7\u0026ndash;8), 233\u0026ndash;238. https://doi.org/10.1177/17504589221076368\u003c/li\u003e\n\u003cli\u003eChowdhury, T., Garg, R., Sheshadri, V., Venkatraghavan, L., Bergese, S. D., Cappellani, R. B., \u0026amp; Schaller, B. (2017b). Perioperative factors contributing the Post-Craniotomy pain: A synthesis of concepts. Frontiers in Medicine, 4. https://doi.org/10.3389/fmed.2017.00023\u003c/li\u003e\n\u003cli\u003eDolmatova, E. V., Imaev, A. A., \u0026amp; Lubnin, A. Y. (2009). \u0026lsquo;Scheduled\u0026rsquo; dosing of lornoxicam provides analgesia superior to that provided by \u0026lsquo;on request\u0026rsquo; dosing following craniotomy. European Journal of Anaesthesiology, 26(8), 633\u0026ndash;637. https://doi.org/10.1097/eja.0b013e328329b0c6 \u003c/li\u003e\n\u003cli\u003eGottschalk, A., Berkow, L. C., Stevens, R. D., Mirski, M., Thompson, R. E., White, E. D., Weingart, J. D., Long, D. M., \u0026amp; Yaster, M. (2007). Prospective evaluation of pain and analgesic use following major elective intracranial surgery. Journal of Neurosurgery, 106(2), 210\u0026ndash;216. https://doi.org/10.3171/jns.2007.106.2.210\u003c/li\u003e\n\u003cli\u003eNewman, L., Vo, P., Zhou, L., Lopez, C. L., Cheadle, A., Olson, M., \u0026amp; Fang, J. (2021). Health care utilization and costs in patients with migraine who have failed previous preventive treatments. Neurology Clinical Practice, 11(3), 206\u0026ndash;215. https://doi.org/10.1212/cpj.0000000000001076\u003c/li\u003e\n\u003cli\u003eRaval, A. D., \u0026amp; Shah, A. (2016). National trends in direct health care expenditures among US adults with migraine: 2004 to 2013. Journal of Pain, 18(1), 96\u0026ndash;107. https://doi.org/10.1016/j.jpain.2016.10.005\u003c/li\u003e\n\u003cli\u003eShaffrey, E. C., Seitz, A. J., Albano, N. J., Israel, J. S., \u0026amp; Afifi, A. M. (2023). Expanding our role in headache management. Annals of Plastic Surgery, 91(2), 245\u0026ndash;256. https://doi.org/10.1097/sap.0000000000003636\u003c/li\u003e\n\u003cli\u003eGrangeon, L., Lange, K. S., Waliszewska-Pros\u0026oacute;ł, M., Onan, D., Marschollek, K., Wiels, W., Mikulenka, P., Farham, F., Gollion, C., \u0026amp; Ducros, A. (2023). Genetics of migraine: where are we now? The Journal of Headache and Pain, 24(1). https://doi.org/10.1186/s10194-023-01547-8\u003c/li\u003e\n\u003cli\u003eLiu, X., Li, S., Wang, B., An, L., Ren, X., \u0026amp; Wu, H. (2015). Intraoperative and Postoperative Anaesthetic and Analgesic Effect of Multipoint Transcutaneous Electrical Acupuncture Stimulation Combined with Sufentanil Anaesthesia in Patients Undergoing Supratentorial Craniotomy. Acupuncture in Medicine, 33(4), 270\u0026ndash;276. https://doi.org/10.1136/acupmed-2014-010749\u003c/li\u003e\n\u003cli\u003eLv, J., Li, P., Zhou, L., Tang, W., \u0026amp; Li, N. (2021). Acupuncture at the P6 Acupoint to Prevent Postoperative Pain after Craniotomy: A Randomized, Placebo-Controlled Study. Evidence-based Complementary and Alternative Medicine, 2021, 1\u0026ndash;8. https://doi.org/10.1155/2021/6619855\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Craniotomy, Chronic headache, HIT-6, Post craniotomy headache, Scalp block","lastPublishedDoi":"10.21203/rs.3.rs-6789798/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6789798/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePersistent 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePCH 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 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.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/em\u003e: not applicable\u003c/p\u003e","manuscriptTitle":"Impact of Scalp Block on Incidence of Persistent Post Craniotomy Headache: A single centre cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-14 11:36:21","doi":"10.21203/rs.3.rs-6789798/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"aa8444bf-8e7c-42e8-a279-dbf54f707a82","owner":[],"postedDate":"July 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-24T08:31:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-14 11:36:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6789798","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6789798","identity":"rs-6789798","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}