Subcutaneous sumatriptan improves quality of recovery after craniotomy

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Subcutaneous sumatriptan improves quality of recovery after craniotomy

In people with headache or migraine, it is thought that some chemicals in the brain increase in activity and as a result, parts of the brain send out confused signals which result in the symptoms of headache and sickness. Many migraine attacks occur for no apparent reason, but for some people there may be things which trigger an attack.

Microvascular Decompression (MVD) is a surgical treatment which is used to treat cranial nerve disorders that are refractory to medical therapies. The postoperative pain of this procedure can be classified as surgical site somatic pain and postcraniotomy headache similar in nature to a migraine, including its association with photophobia, nausea, and vomiting. This headache may affect the quality of recovery and has the potential for development of chronic pain Such type of headache is extremely difficult to treat and these complications have a impact on patients postoperative recovery.

There are many alternative therapies that help migraine headaches that has entered the spotlight recently is Sumatriptan. Sumatriptan is used to treat migraine-like headaches in various settings. It belongs to a class of 5-hydroxytryptamine (5HT)-receptor agonists. Triptans work by stimulating the serotonin receptors and this eases the symptoms of migraine and cluster headaches.

A single centered randomized controlled trial has been conducted to examine the effectiveness of sumatriptan in controlling pain and quality of postoperative recovery in patients with postcraniotomy headache after MVD surgery. Subcutaneous sumatriptan (6mg) or saline was given to 50 patients who complained of postoperative headache after MVD. The primary outcome of the study was quality of recovery as measured by the Quality of Recovery-40 (QoR-40) score at 24 hour.

Scientists took into account that in sumatriptan group QoR-40 scores were significantly higher than in the placebo group. Findings from this study suggesting higher quality of recovery. Moreover, significantly more patients reported lower headache scores at 4, 12, and 24 hour postoperatively in the sumatriptan treatment period versus in the placebo treatment period.

This study showed that this may present as a useful alternative treatment for post-craniotomy headache. The precise mechanism remains unknown but may be related to reduction in headache or mood modulation mediated by a serotonin effect.

British Journal of Anaesthesia
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