Inequalities in maternal health service utilisation in Somalia: analysis of the 2020 Somali health and demographic survey.

Headache onset following a craniotomy is a well-described post-surgical complication, initially recognized as a consequence of vestibular schwannoma resection in the 1980s []. A majority of these headaches resolve within one month, however a subset persists. The International Classification of Headache Disorders, 3rd Edition (ICHD-3), recognizes two distinct diagnoses: acute headache attributed to craniotomy and persistent headache attributed to craniotomy. The acute phenotype is defined as a headache of less than 3 months duration (whether it resolved within 3 months or 3 months have not passed since its onset), while the persistent phenotype is diagnosed if the headache has lasted greater than 3 months. Both diagnoses require that a surgical craniotomy has been performed, the headache onset occurred within 7 days of (1) the craniotomy, (2) regaining consciousness following the craniotomy, or (3) the discontinuation of medications impairing ability to accurately sense or report symptoms following the craniotomy, as well as not better accounted for by another ICHD-3 diagnosis []. About 1 in 4 patients with a diagnosis of acute headache attributed to craniotomy experience ongoing headache that later meets criteria for persistent headache attributed to craniotomy []. Recommendations have also been made to consider extending the onset to greater than 7 days, as there is a population of patients who develop a delayed post-craniotomy headache (PCH) []. Literature and clinical expertise suggest that PCH can have varying phenotypes including migrainous, tension-type, neuralgiform, and cervicogenic, though there are no formal recommendations to designate as such [–]. Recognition, evaluation, and appropriate management of this disorder is crucial as PCH can be incapacitating and interfere with daily functioning and mood []. Management of persistent PCH has historically relied on neuropathic pain agents. However, emerging case reports and case series have shown encouraging responses to various protocols using onabotulinumtoxinA (BoNT/A) and nerve blocks, which will be highlighted in this review. This is a narrative review of literature focused on publications from 2021 to 2026, while incorporating seminal earlier studies on epidemiology, pathophysiology, and management. It includes case reports, case series, systematic reviews, and other literature concerning acute and persistent pain management after craniotomy. The data were collected by doing a search of PubMed and a manual search of all pertinent references in the literature. The keywords used were post-craniotomy headache, persistent post-craniotomy headache, and post-craniotomy pain.