Sumatriptan for Postcraniotomy Headache after Minimally Invasive Craniotomy for Clipping of Aneurysms: A Prospective Randomized Controlled Trial.

Introduction  Postcraniotomy headaches are often underestimated and undertreaded. This study aimed to identify if postoperative administration of sumatriptan after minimally invasive craniotomy for clipping an unruptured aneurysm could reduce postcraniotomy headache and improve the quality of postoperative recovery. Settings and Design  Tertiary care center, single-center randomized double-blind placebo-controlled trial. Materials and Methods  Patients who complained of postoperative headaches after minimally invasive craniotomy for clipping of unruptured aneurysms were randomized to receive subcutaneous sumatriptan (6 mg) or placebo. The primary outcome was the quality of recovery measured 24 hours after surgery. Secondary outcomes were total opioid use and headache score at 24 hours after surgery. Data were analyzed using a Student's t -test or the chi-square test. Results  Forty patients were randomized to receive sumatriptan ( n  = 19) or placebo ( n  = 21). Both groups had similar demographics, comorbidities, and anesthesia management. The Quality of Recovery 40 score was higher for patients receiving sumatriptan compared to placebo, however, not statistically significant (173 [156-196] vs. 148 [139-181], p  = 0.055). Postoperative opioid use between sumatriptan and placebo was lower, but not significant (5.4 vs. 5.6 mg morphine equivalent, p  = 0.71). The severity of headache was also not statistically different between the two groups (5 [4-5] vs. 4 [2-5], p  = 0.155). Conclusion  In patients undergoing minimally invasive craniotomies for aneurysm clipping, sumatriptan given postoperatively has a nonsignificant trend for a higher quality of recovery. Similarly, there was a nonsignificant trend toward lower postcraniotomy headache scores and opioid scores for the patient given sumatriptan.