Does Anesthesia Type Impact Postoperative Migraine Risk?

A nation-wide study carried out in Taiwan found no difference in the risk of postoperative migraine between patients undergoing general and neuraxial anesthesia, and identified risk factors for postoperative migraine headaches. Findings were published in International Journal of Environmental Research and Public Health.

“Surgical patients are predisposed to migraine headaches due to stress, mental tension, and bright lights in the perioperative period,” authors explained, while “postoperative migraine headaches can cause emotional distress, induce sleep disorders, and impair health-related quality of life in surgical patients.”

Previous research has revealed migraineurs can also have increased risks of some perioperative complications like vomiting, ischemic stroke, and rehospitalization, they added.

As the overall effect of general anesthesia on migraine remains unknown, and evidence is unclear on whether general anesthesia increases migraine risk compared with other forms, investigators utilized Taiwan’s National Health Insurance research database to conduct a nationwide population-based cohort study.

Deidentified data from individuals who underwent their first surgical procedures requiring general or neuraxial anesthesia between January 2002 and June 2013 were considered for inclusion. All patients had a least a 2-day stay in the hospital following the procedure; those who received general anesthesia (n = 68,131) were matched 1:1 with patients who received neuraxial anesthesia (n = 68,131).

International Classification of Diseases, 9th Revision, Clinical Modification codes were used to identify individuals who developed postoperative migraine.

“In the matched cohort, 658 patients developed a new-onset migraine during the half-year 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 for patients undergoing general and neuraxial anesthesia, respectively.”

Analyses revealed:

• General anesthesia was not associated with a greater risk of migraine compared with neuraxial anesthesia (adjusted odds ratio [aOR], 0.93; 95% CI, 0.80-1.09); this finding was consistent across subgroups of different migraine subtypes, uses of migraine medications, and varying postoperative periods
• Influential factors for postoperative migraine were age (aOR, 0.99), sex (male vs female; aOR, 0.50), preexisting anxiety disorder (aOR, 2.43) or depressive disorder (aOR, 2.29), concurrent uses 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 sex, preexisting anxiety and depression disorders, and a greater number of preoperative emergency department visits were associated with an increased risk of postoperative migraine.

The stress of surgery has been identified as an important trigger for migraine; however, it is “uncertain whether the stress of surgery modifies the migraine risk among patients with mental health disorders,” the researchers noted.

Because propofol is commonly used during general anesthesia, the investigators hypothesized this drug’s mechanism of inhibiting the activity of central serotonergic neurons in the raphe nuclei could theoretically exert anti-migraine effects. The treatment also reduces cerebral blood flow and cerebral metabolic rate, which could prevent migraine development.

“Future studies are needed to investigate the potential impact of different regimens of general anesthesia on the risk of postoperative migraine, such as propofol-based total intravenous anesthesia and opioid-free general anesthesia,” they said.

More research is also warranted on the potential neurophysiological effects of theophylline on migraine; whether avoiding theophylline, corticosteroids, and ephedrine serves to prevent postoperative migraine remains to be seen. In addition, future studies should investigate what proportion of postoperative migraine progresses to chronic migraine.

A lack of data on physical measures, socioeconomic factors, and other potentially confounding characteristics marks a limitation to this study. The researchers also excluded all patients presenting with chronic migraine prior to surgery, while any procedure that could only be conducted using general anesthesia was also excluded.

However, “these findings may provide an implication for early diagnoses and prompt interventions of postoperative migraine headaches,” the authors concluded. “More studies are needed to diagnose and evaluate postoperative migraines among patients receiving different anesthetics in the immediate postoperative period.”

Reference

Liao C, Li C, Liu H, et al. Migraine headaches after major surgery with general or neuraxial anesthesia: a nation-wide propensity-score matched study. Int J Environ Res Public Health. Published online December 30, 2021. doi:10.3390/ijerph19010362