Cyclooxygenase 2 Inhibitors for Headache After Elective Cranial Neurosurgery: Results from a Systematic Review of Efficacy of Cyclooxygenase 2 Inhibitors for Headache After Acute Brain Injury

Authors

Hector David Comparan, Division of Neurocritical Care, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, 32611, USA.
Anum Khaliq, Division of Neurocritical Care, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, 32611, USA.Follow
Luciola Martins Frota, Division of Neurocritical Care, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, 32611, USA.Follow
Daniela Pomar-Forero, Division of Neurocritical Care, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, 32611, USA.Follow
Bakhtawar Ahmad, Division of Neurocritical Care, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, 32611, USA.Follow
Erica Marnet, Department of Medicine, Bridgeport Hospital, Bridgeport, CT, 06610, USA.Follow
Fernanda J. Teixeira, Department of Neurology, University of Miami and Jackson Memorial Hospital, Miami, FL, 33130, USA.Follow
Anita Thomas, Division of Neurocritical Care, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, 32611, USA.Follow
Priyank Patel, Division of Neurocritical Care, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, 32611, USA.Follow
Haley Brunkal, Division of Neurocritical Care, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, 32611, USA.Follow
Saanvi Singireddy, Division of Neurocritical Care, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, 32611, USA.Follow
Brandon Lucke-Wold, Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, 32611, USA.Follow

Document Type

Article

Publication Title

Neurocritical care

Abstract

Headache management after acute brain injury (ABI) is challenging. Although opioids are commonly used, selective cyclooxygenase 2 inhibitors (COXIBs) may be promising alternatives. However, concerns about cardiovascular effects and bleeding risk have limited their use. We aimed at summarizing available data on efficacy of COXIBs for headache management following ABI. A systematic review was conducted through MEDLINE and Embase for articles published through September 2023 (PROSPERO identifier: CRD42022320453). No language filters were applied to the initial searches. Interventional or observational studies and systematic reviews assessing efficacy of COXIBs for headache in adults with ABI were eligible. Article selection was performed by two independent reviewers using DistillerSR. Descriptive statistics were used for data analysis, and meta-analysis was unfeasible because of study heterogeneity. Of 3190 articles identified, 6 studies met inclusion criteria: 4 randomized controlled trials and 2 retrospective cohort studies, all conducted in elective cranial neurosurgical patients (total N = 738) between 2006 and 2022. Five studies used COXIBs in the intervention group only. Of the six studies, four found a reduction in overall pain scores in the intervention group, whereas one showed improvement only at 6 h postoperatively, and one did not find significant differences. Pain scores decreased between 4 and 15%, the largest shift being from moderate to mild severity. Three studies found an overall opioid use reduction throughout hospitalization in the intervention group, whereas one reported a reduction at 12 h postoperatively only. Opioid consumption decreased between 9 and 90%. Two studies found a decrease in hospital length of stay by ~ 1 day in the intervention group. The one study reporting postoperative hemorrhage found a statistically nonsignificant 3% reduction in the intervention group. COXIBs may serve as opioid-sparing adjunctive analgesics for headache control after elective cranial surgery. Limited or no literature exists for other forms of ABI, and additional safety data remain to be elucidated.

DOI

10.1007/s12028-024-02114-y

Publication Date

9-12-2024

Recommended Citation

Comparan, Hector David; Khaliq, Anum; Frota, Luciola Martins; Pomar-Forero, Daniela; Ahmad, Bakhtawar; Marnet, Erica; Teixeira, Fernanda J.; Thomas, Anita; Patel, Priyank; Brunkal, Haley; Singireddy, Saanvi; and Lucke-Wold, Brandon, "Cyclooxygenase 2 Inhibitors for Headache After Elective Cranial Neurosurgery: Results from a Systematic Review of Efficacy of Cyclooxygenase 2 Inhibitors for Headache After Acute Brain Injury" (2024). Internal Medicine. 59.
https://scholar.bridgeporthospital.org/internal_medicine/59

Identifier

39266865 (pubmed); 10.1007/s12028-024-02114-y (doi); 10.1007/s12028-024-02114-y (pii)