From the Research
Headache is not a major problem after anterior cervical discectomy, as most patients experience significant improvement in headache symptoms after surgery, with sustained relief up to 10 years postoperative. According to the study by 1, 86% of patients with radiculopathy or myelopathy complained of headaches preoperatively, but by 6 weeks postoperative, only 12.5% had severe headaches, and at 10-year follow-up, 16.8% had severe headaches. The study by 2 also found that headache improvement was sustained over the long-term period with both ACDF and CDA populations.
The management of postoperative headaches typically involves standard analgesics like acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) and NSAIDs such as ibuprofen (400-600mg every 6-8 hours with food) if not contraindicated. Positioning is important, and patients should use a soft cervical collar as directed and avoid extreme neck positions. Ice packs applied to the neck for 15-20 minutes every 2-3 hours can help reduce inflammation and pain.
Some key points to consider:
- Headache relief after anterior cervical discectomy is sustained over the long-term period, up to 10 years postoperative 1
- Both ACDF and CDA are effective in alleviating headaches associated with radiculopathy or myelopathy 1
- The mechanism of headache reduction remains unclear, but it is thought to be related to the improvement in cervical kinematics and preservation of range of motion at adjacent uncovertebral joints 2
- Patients should be aware that persistent or severe headaches, especially when accompanied by fever, neck stiffness, or neurological symptoms, warrant immediate medical attention as they could indicate complications like CSF leak, infection, or hematoma.
In terms of specific treatment options, the study by 3 found that both CDA and ACDF at either one or two levels are associated with sustained headache relief from baseline, with patients undergoing two-level arthroplasty having significantly greater improvement in headache at all points except for at 18 and 60 months. However, the study by 2 found that for 2-level treatment, CDA patients had significantly improved headache scores versus ACDF patients at the 7-year point.
Overall, the current evidence suggests that headache is not a major problem after anterior cervical discectomy, and that both ACDF and CDA are effective in alleviating headaches associated with radiculopathy or myelopathy.