5.5 Acute headache attributed to craniotomy


Headache of less than 3 months’ duration caused by surgical craniotomy.

Diagnostic criteria:
  1. Any headache fulfilling criteria C and D
  2. Surgical craniotomy1 has been performed
  3. Headache is reported to have developed within 7 days after one of the following:
    1. the craniotomy
    2. regaining of consciousness following the craniotomy
    3. discontinuation of medication(s) impairing ability to sense or report headache following the craniotomy
  4. Either of the following:
    1. headache has resolved within 3 months after its onset
    2. headache has not yet resolved but 3 months have not yet passed since its onset
  5. Not better accounted for by another ICHD-3 diagnosis1;2.
  1. When the craniotomy was performed following and because of head injury, code as 5.1.1 Acute headache attributed to moderate or severe traumatic injury to the head.
  2. Exclusion of other secondary headache disorders that may occur following craniotomy is necessary prior to assigning the diagnosis of 5.5 Acute headache attributed to craniotomy. Although there are numerous potential aetiologies of headache following craniotomy, consideration should particularly include cervicogenic headache (due to positioning during surgery), headache from cerebrospinal fluid leak, infections, hydrocephalus and intracranial haemorrhage.

5.5 Acute headache attributed to craniotomy occurs in a substantial proportion of patients undergoing surgical craniotomy. In the majority of cases, it begins within the first few days after craniotomy and resolves within the acute post-operative period. It is more common after surgery of the skull base compared to other locations.

Although the pain of 5.5 Acute headache attributed to craniotomy is often felt maximally at the site of craniotomy, it may be more diffuse and resemble tension-type headache or migraine.