Incidence, Characteristics, and Risk Factors of Post-Radiosurgery Headaches: A Prospective Observational Study

Aims

This prospective observational study aimed to characterize the incidence, clinical features, and risk factors of headaches following CyberKnife radiosurgery (CKRS) in patients with intracranial pathologies.

Methods

In a prospective observational study conducted from January 2022 to January 2023, we enrolled consecutive patients who underwent CKRS. Patients completed headache-related questionnaires developed based on the International Classification of Headache Disorders (ICHD-3) guidelines at 24 h, 1 week, and 3 months post-radiosurgery. The incidence of CKRS-related headaches was determined, and the link between risk factors and outcomes was analyzed.

Results

Of 153 patients (female 58.2%; mean age 47.7 ± 14.8 years), all completed a 3-month follow-up. Among 153 patients, 61 (39.9%) developed post-CKRS headaches, with 83.6% reporting peak intensity within 2 weeks post-procedure. Fifty (32.7%) developed headaches within 2 weeks, resolving within 3 months. A strong temporal association between headache onset and CKRS supports a causal relationship. Multivariate Cox regression analysis identified female sex (HR = 2.16, 95% CI = 1.14–4.11, p = 0.019), younger age (HR = 0.97 per year, p = 0.006), absence of prior craniocerebral surgery (HR = 0.55, p = 0.046), and multiple lesions (HR = 2.28, p = 0.047) as independent risk factors. Although headaches were more frequently observed following radiation targeting the basal ganglia and thalamus, this association lacked statistical significance (p > 0.05).

Conclusions

Headaches attributed to brain radiosurgery constitute a significant yet overlooked clinical issue, warranting increased focus from surgical teams to deliver improved and tailored treatment.