Management of Post-Operative Headache

Initial Assessment and Treatment

The American College of Surgeons recommends a multimodal analgesic strategy starting with non-opioid medications such as acetaminophen, NSAIDs, and magnesium for managing post-operative headache, with a strength of evidence level of high 1, 2
The World Health Organization suggests that younger age is a risk factor for post-operative headache 2

The American Academy of Neurology recommends a migraine cocktail consisting of saline bolus, ondansetron, magnesium, and acetaminophen for post-operative headache, with a strength of evidence level of moderate 3, 4, 5, 1
The American Society of Anesthesiologists suggests prioritizing non-opioid medications such as acetaminophen and NSAIDs as first-line therapy for post-operative headache, with a strength of evidence level of high 1, 2

The British Journal of Anaesthesia recommends considering dexamethasone 8 mg IV and strong opiates for severe post-operative headache unresponsive to first-line treatments, with a strength of evidence level of moderate 6, 7
The Mayo Clinic suggests using triptans for patients with migraine-like characteristics, but holding them on the day of surgery, with a strength of evidence level of low 5

The World Federation of Neurosurgical Societies recommends evaluating for potential complications such as cerebrospinal fluid leak, intracranial hypotension, and post-dural puncture headache in patients with persistent post-operative headache, with a strength of evidence level of high 3, 4, 8
The American Society of Anesthesiologists suggests monitoring patients receiving opioids for respiratory depression and evaluating for potential postoperative complications, with a strength of evidence level of high 9, 2

The British Journal of Anaesthesia recommends referring patients still taking opioids 90 days after surgery for further assessment and considering referral to neurology for persistent headaches unresponsive to standard treatment, with a strength of evidence level of moderate 7, 3, 4
The American Academy of Pain Medicine suggests using validated tools for regular pain assessment to ensure proper management and early detection of complications, with a strength of evidence level of high 9, 2

The American Society of Anesthesiologists recommends considering preemptive analgesia with NSAIDs and dexamethasone 8 mg IV during surgery for high-risk patients, with a strength of evidence level of moderate 6, 2