New research identified risk factors for postoperative migraine and compared the occurrence of migraine after general or neuroaxial anesthesia.
A nationwide study conducted in Taiwan found no difference in the risk of postoperative migraine headaches between patients undergoing general anesthesia and neuraxial anesthesia and identified risk factors for postoperative migraine headaches. The results were published in International Journal of Environmental Research and Public Health.
“Surgical patients are predisposed to migraine headaches due to stress, psychological tension, and bright light in the perioperative period,” the authors explained, while “postoperative migraine headaches can cause emotional distress, induce sleep disturbance, and impair health-related quality of life in surgical patients.”
Previous research has shown that migraineurs may also be at increased risk of some perioperative complications, such as vomiting, ischemic stroke and rehospitalization, they added.
Because the overall effect of general anesthesia on migraines remains unknown, and evidence is unclear as to whether general anesthesia increases the risk of migraines compared to other forms, the researchers used the Taiwan National Health Insurance Fund’s research database to conduct a nationwide population-based cohort study.
Anonymized data from subjects who underwent their first surgical procedures requiring general or neuraxial anesthesia between January 2002 and June 2013 were considered for inclusion. All patients had to stay in the hospital for at least 2 days after the procedure; those receiving general anesthesia (n=68,131) were matched 1:1 with patients receiving neuraxial anesthesia (n=68,131).
International Classification of Diseases, 9th Revision, Clinical Modification Codes were used to identify individuals who developed postoperative migraines.
“In the matched cohort, 658 patients developed a new onset migraine during the six-month follow-up and 318 and 340 after general and neuraxial anesthesia, respectively,” the authors wrote. “The overall incidence of migraine was 9.82 per 1000 person-years and 9.49 and 10.15 in patients undergoing general and neuroaxial anesthesia, respectively.”
- General anesthesia was not associated with a higher risk of migraines compared to neuraxial anesthesia (adjusted odds ratio [aOR], 0.93; 95% CI, 0.80-1.09); This finding was consistent across subgroups of different migraine subtypes, migraine medication use, and different postoperative periods
- Factors influencing postoperative migraines were age (aOR, 0.99), gender (male vs. female; aOR, 0.50), pre-existing anxiety disorder (aOR, 2.43) or depressive disorder (aOR, 2.29), concomitant use of systemic corticosteroids (aOR, 1.45), ephedrine (aOR, 1.45), theophylline (aOR, 1.40), and number of emergency department visits before surgery (1 vs. 0, aOR, 1.12; 2 vs 0, aOR, 1.14; ≥3 vs 0, aOR, 1.68)
Overall, younger age, female gender, pre-existing anxiety and depressive disorders, and greater number of preoperative emergency visits were associated with an increased risk of postoperative migraines.
Surgical stress has been identified as an important trigger for migraines; However, it is “uncertain whether surgical stress alters migraine risk in patients with mental disorders,” the researchers noted.
Because propofol is commonly used during general anesthesia, the researchers hypothesized that this drug’s mechanism for inhibiting the activity of central serotonergic neurons in the raphe nuclei could theoretically have anti-migraine effects. Treatment also reduces cerebral blood flow and cerebral metabolic rate, which could prevent migraines from developing.
“Future studies are needed to investigate the potential impact of different general anesthetic regimens on the risk of postoperative migraines, such as: B. Propofol-based total intravenous anesthesia and opioid-free general anesthesia,” they said.
Further research on theophylline’s potential neurophysiological effects on migraine is also warranted; whether avoidance of theophylline, corticosteroids, and ephedrine helps prevent postoperative migraines remains to be seen. In addition, future studies should investigate what proportion of postoperative migraines progress to chronic migraines.
A lack of data on physical measurements, socioeconomic factors, and other potentially confounding characteristics marks a limitation of this study. The researchers also excluded all patients with chronic migraines before surgery, while all procedures that could only be performed under general anesthesia were also excluded.
“However, these findings may provide an implication for early diagnosis and prompt intervention in postoperative migraine headaches,” the authors concluded. “Further studies are needed to diagnose and evaluate postoperative migraine in patients receiving different anesthetic agents in the immediate postoperative period.”
Liao C, Li C, Liu H, et al. Migraine headache after major surgery with general or neuraxial anesthesia: a nationwide propensity score-matched study. Int J Environ Res Public Health. Published online December 30, 2021. doi:10.3390/ijerph19010362