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Incidence and factors associated with postoperative headache among adult elective surgical patients at the university of gondar comprehensive specialized hospital, northwest Ethiopia, 2022: a prospective follow-up study

BMC Anesthesiology volume 25, Article number: 44 (2025) Cite this article

Abstract

Background

Postoperative headache is a medical condition that has a strong association with future recurrence and chronic headache, higher morbidity and mortality, extended hospital stays, poor quality of life and high financial burden. Despite, having these consequences, there are limited studies in the study area.

Objective

This study aimed to assess the incidence and associated factors of postoperative headache among adult elective surgical patients at the University of Gondar Comprehensive Specialized Hospital Northwest Ethiopia, April 9 to 20 June 2022.

Methods

An institution -based follow- up study was conducted from April 9 to June 20, 2022, at the University of Gondar Comprehensive Specialized Hospital, after ethical approval and 424 patients were included. Postoperative headache was assessed with patient interview and the response was dichotomized as present or absent. Data was collected through chart review and patient interviews using a questionnaire. Data was entered into Epidata 4.6.0 and statistical analysis was performed using stata version 14.01. Descriptive statistics was conducted to summarize patient information and determine the outcome’s incidence. Binary logistic regression was conducted to identify factors associated with postoperative headache. Variables with P-value < 0.05 were considered statistically significant.

Results

The overall incidence of postoperative headache in the first three postoperative days was 54.3% (228) and the response rate was 99%. Previous history of headache (AOR = 4.83, CI = 2.42 9.73), prolonged fasting (AOR = 2.28, CI = 1.44–3.60), general anesthesia (AOR = 1.96, CI = 1.25–3.07), intraoperative hypotension (AOR = 1.74,CI = 1.06–2.88), being female (AOR = 1.62,CI = 1.06–2.54) and caffeine consumption(AOR = 1.60,CI = 1.02–2.52) were significant factors associated with postoperative headache and most of patients 89(21.2%) had moderate headache.

Conclusion and recommendations

More than half of patients were suffered from postoperative headache. Use of general anesthesia, having prior history of headache, being female, intraoperative hypotension, caffeine consumption and prolonged preoperative fasting were strongly associated with postoperative headache. The problem needs regular assessment and treatment.

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Introduction

Headache is conceptualized as a somatic and chronic disorder with acute episodes of pain, resulting in varying levels of disability, emotional distress and disruption of daily life [1, 2].

The International Classification of Headache Disorders (ICHD-3) classified headaches in to three different groups: Primary headaches, secondary headaches and neuropathies and facial pains and other headaches. Primary headaches includes; migraine, tension-type headache (TTH), trigeminal autonomic cephalalgias (TACs) and other primary headache disorders. Secondary headache includes; headache attributed to trauma or injury to the head and/or neck, headache attributed to cranial or cervical vascular disorder, headache attributed to nonvascular intracranial disorder, headache attributed to a substance or its withdrawal, headache attributed to infection, headache attributed to homeostasis disorder, headache or facial pain attributed to facial or cervical structures and headache attributed to psychiatric disorder. Neuropathies and facial pains and other headaches includes; painful lesions of the cranial nerves and other facial pain and other headache disorders [3].

In different studies, it has been reported that postoperative headache (POH) is distressing complication of anesthesia and surgery and, reach 54% up to 84% [4,5,6,7,8].

It is the most commonly reported neurologic condition and can be severely disabling with several underlying causes, including primary headache disorders and secondary causes. It is a public health problem of major concern in all countries and it represents a drain on a country’s productivity. The economic costs involved (direct and indirect) as well as the psychosocial and human costs are enormous burden on society in general [9, 10].

Postoperative headache is a complication that occurs shortly after anesthesia. It is associated with increased morbidity, prolonged hospital stays, poor quality of life and additional economic burdens and constitutes a health problem [11, 12].

It has also been shown that POH increases the requirements for pain medications and affects the overall patient satisfaction and even delays patients’ discharge from hospital. In the postoperative period, many patients develop postoperative symptoms, most of which are attributable to anesthesia and surgery. These symptoms persist for more than 24 h, and implicated as the main reason for decreased mobilization after surgery and anesthesia [13, 14].

In a study conducted in USA suggested that the risk of post-surgical hospital readmission due to pain was reduced by 35% in patients who received painkiller in the perioperative period [15].

Different studies reported that the risk of POH and its complications is elevated specifically in patients who undergo ambulatory surgery and it also prolongs hospital stay [16, 17].

In patients who underwent ambulatory surgical procedures, postoperative headache was identified as a major risk factor for 30 day hospital readmission. Patients present to hospital with varied symptoms. However, they usually present with headache and abdominal pain. Surgical patients with a history of headache are at an elevated risk of perioperative ischemic stroke. It is therefore, recommended that chronic headache be considered in the risk assessment for perioperative ischemic stroke [15, 16, 18].

Treatment of headache requires multidisciplinary approaches includes; obtaining history, description of the headache(quality, severity and location) following this, narcotics and gabapentin can be used to treat severe headache in the postsurgical period [19, 20].

Caffeine supplementation of surgical patients is part of the enhanced recovery after surgery program(ERAS).Adding caffeine both intravenous and oral caffeine in the perioperative period in chronic caffeinators can reduce the incidence of caffeine withdrawal headache in the perioperative period [21]. Although, there are different studies on the incidence of postoperative headache and associated factors in the abroad, as it is described below in conceptual frame work (Fig. 1), there are limited studies both in the study area and all over the country, Ethiopia. There is no published data in the study area and in the country. So, we hope the study will provide a base line data regarding the incidence and associated factors of postoperative headache.

Fig. 1
figure 1

Conceptual frame work for the incidence of postoperative headache and possible factors

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Objective

The objective of this study was to assess the incidence and factors associated with postoperative headache among adult elective surgical patients at University of Gondar Comprehensive Specialized Hospital Northwest Ethiopia.

Methods

Study design and period

An institution-based prospective follow-up study was conducted from 9 April to June 20, 2022.

Source and study population

Source population

All surgical patients who were admitted to University of Gondar Comprehensive Specialized Hospital for operation were our source populations.

Study population

All adult elective surgical patients who underwent surgery during the study period.

Eligibility criteria

Inclusion criteria

All adult elective surgical patients who were operated during the study period were included.

Exclusion criteria

Patients with cognitive dysfunction and communication problem, pregnant mothers, patients operated under local anesthesia and patients who were directly transferred to intensive care unit were excluded.

Study variables

Dependent variable

Postoperative headache.

Independent variables

Age, gender, daily caffeine consumption, duration of preoperative fasting, prior history of headache, general anesthesia technique, intraoperative-hypotension and hypertension, smoking, alcohol consumption, low albumin level, increased white blood cell count, type of surgery, intraoperative hypercarbia, intraoperative hypoxemia.

Operational definition

Postoperative headache

The presence of headache mostly within 3 days of postoperative period.

Smoking history

A record of an individual’s background in regard to smoking tobacco.

Prolonged fasting

A fasting time or nothing per os of ≥ 16 h.

Hypertension

If there is greater than 20% of systolic blood pressure from the base line it will be considered as hypertension.

Hypotension

A decrement of systolic blood pressure greater than 20% from the base line it will be considered as intraoperative hypotension.

Alcohol history

was rated as (non-drinkers) individuals who never drink any kind of alcohol, frequent- drinkers’ individuals who drink any kind of alcohol once or more days per week and ex-drinkers individuals who do not drink any kind of alcohol currently but who used to drink alcohol in the past. Generally if a person drinks one or more bottle of alcohol per day frequently so that we can say the patient has alcoholic history.

Previous or prior history of headache

Defined as self-reported or recorded migraine or any other kind of recurrent headache before surgical exposure.

Intraoperative hypoxemia

If the intraoperative oxygen saturation of the patient decreases below 90% which is measured by pulse-oximetry.

Intraoperative hypercarbia

If there is any intraoperative increment of end tidal carbon dioxide (> 50 mmhg as measured by capno-meter).

History of caffeine consumption

If someone has a habit of taking caffeine of 400mgs per day.

Sample size and sampling procedure

Sampling procedure

For this particular study, all consecutive patients who underwent elective surgery in the study period were selected based on inclusion and exclusion criteria. Data was collected till the calculated sample size was reached.

Sample size determination

A single population proportion was used to estimate the sample size. A 50% incidence of postoperative headache with a margin of error (d) of 5% at a confidence level of 95% was assumed and a 10% non-response rate was added and the final minimum estimated sample size was n = 424.

Data collection procedures

Data were collected by two data collectors after being given training about the data collection procedure and they were supervised by a postgraduate anesthesia student and the principal investigator. The data collection procedure included an observational checklist and an interview based on questionnaire. The data collectors were requested to select voluntary participants to interview and record anesthetic and surgical data. A structured questionnaire obtained from a previous study conducted to assess postoperative headache was used for data collection [13]. Information regarding demographic variables like, Age, Sex, Previous history of headache, History of smoking, History of alcohol, Caffeine consumption, Family history of headache and NPO-status was obtained by interviewing patients preoperatively. Data regarding, American society of anesthesiologist’s physical status of the patient (ASA), intraoperative hypotension, intraoperative hypertension, intraoperative hypoxemia and the respective measures taken, intraoperative blood transfusion, type of anesthesia, anesthetic drugs used intraoperatively, both for induction and maintenance, type of surgery, position of the patient during surgery, duration of anesthesia and surgery were taken from the anesthesia recording sheet and patients chart. Headache severity can be reliably measured in self-reporting population with one dimensional tools and the visual analogue scale is considered appropriate (VAS). It ranges from no headache (0) to the worst possible headache. Patients were grouped into having no headache (score of 0), having mild headache (score of 1–3), having moderate headache (score of 4–6) and having severe headache (score of 7–10). So, visual analogue scale was used to assess severity of postoperative headache.

Patients were interviewed with questionnaires six hours after surgery and were followed up to the 72th postoperative hours. Since the common occurrence of Postoperative headache is during the first 48 h after surgery where the maximum incidence occurs during the first 12 h after surgery we followed patients for three postoperative days [22]. Patients who developed POH during the data collection were advised to seek medical care and the responsible heath care providers were informed about the headache each patient had.

Data quality assurance

Training was given for two data collectors before the start of data collection. The training was basically about how they should approach study subjects, how they could use the data collection tool and keeping the privacy of study subjects. The data collectors were final year anesthesia BSC students and they were supervised by one Anesthesia post graduate student and other activities were covered by the principal investigator. To ensure the quality of data, a pretest was carried out using 5% (22 patients) of the sample population and these patients were excluded from the main study. The pretest was conducted in the UOGCSH two weeks prior to the start of the actual data collection. The purpose of the pretest was to check the questionnaire for completeness and comprehensibility. The actual data collection was started by patient interviews and by extracting data from patient medical records. The consent form was translated into Amharic using an online Google English to Amharic translator.

Data management and statistical analysis

After ensuring that the data was complete and consistent, it was cleaned, coded and entered to Epi data version 4.6.0 before being exported to stata software version 14.01 for analysis. Tables and texts were used to present the data, which included both descriptive and analytic statistics. Categorical variables are presented with frequencies and percentages and corresponding cross-tabulation values are presented in tables. The association between categorical variables was tested using chi- square test. Binary logistic regression was conducted to identify factors associated with postoperative headache. All independent variables were identified using bivariate logistic regression and Factors with P-value < 0.2 during the bivariate analysis were further entered into multivariate logistic regression analysis to identify independent risk factors. Multi-Co-linearity of covariates was assessed. To check for their association with the dependent variable (POH) p-value < 0.05 was considered statistically significant. The strength of association was presented using both crude and adjusted odds ratios with their respective confidence intervals. Hosmer Lemeshow test of goodness of fit was used to check the appropriateness of the model for analysis and the model was found to be appropriate.

Ethics committee approval

Before the start of actual data collection, ethical clearance was obtained from Ethical clearance was obtained from University of Gondar College of Medicine and Health Science, School of Medicine, Ethical Review Committee with date and reference number of 25/3/2022 and Ref.No SOM/1404/2022, respectively. The objective of the study was explained to each study participant explicitly. Both written and verbal informed consent was obtained from each study participant after a clear explanation of the merits of the study. Study participants were informed that they had free will to abandon the study at any time. The data was kept secret in a way that only the researcher could get access to it. The privacy of patients during data collection was kept confidential. Confidentiality was maintained at all levels of this study by avoiding identifiers, using codes to identify each participant, keeping the privacy of each study participant during data collection and locking questionnaires securely.

Results

In this study, a total of 424 patients who met our inclusion criteria were included and the response rate was 99%. Four patients were excluded from analysis, because of incomplete data as they were discharged earlier than 24 h after surgery.

Socio -demographic and clinical characteristics of study participants

More than half of our study populations were males (233) and majority of study participants were in the age between18 and 29 years (42.2%). From the total study participants 60.5% of them were ASA class I. More than one third of our study participants (37.9%) had a preoperative fasting time of ≥ 16 h and 30.2% of participants had a baseline serum albumin investigation that revealed 6.7% of them had low albumin level. (Table 1).

Table 1 Socio-demographic characteristics of postoperative patients at the University of Gondar comprehensive specialized hospital in northwest Ethiopia from April 9 to June 20, 2022(N = 420)
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Personal habits and previous history of headache

This study showed that 20.2% (85) of participants had prior history of headache and 18.8% (79) of participants had family history of headache (Table 2).

Table 2 Habits and prior history of headache of postoperative patients at the University of Gondar Comprehensive Specialized Hospital in Northwest Ethiopia from April 9 to June 20, 2022(N = 420)
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Clinical data of study participants

The majority of our study participants were operated under general anesthesia and majority of them were induced with combined ketamine and propofol. Isoflurane was the only inhalational anesthetic agent used for maintenance in all cases. More than half of type of surgery was categorized under general surgery (n = 223) which incorporates; genitourinary surgery (n = 25), Neurosurgery (n = 30), ENT surgery (n = 88), gastrointestinal surgery (n = 60) and hepatobiliary surgery (n = 20) and most of participants were operated in supine position. The duration of surgery in majority of the cases was from 1 to 3 h. (Table 3)

Table 3 Anesthetic and surgical characteristics of study participants at the University of Gondar Comprehensive Specialized Hospital in Northwest Ethiopia from April 9 to June20, 2022(N = 420)
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The overall incidence and severity of postoperative headache

The overall incidence of postoperative headache in the current study was found to be 54.3% (95% CI = 49.5–59.0). In patients who developed postoperative headache, the highest incidence 80.7% (184) was observed at day one of postoperative period. At day one about 60% and 20.6% patients developed postoperative headache at 12 and 24 h of postoperative period, respectively. The incidence of severity of mild, moderate and severe postoperative headache was 14.3%, 21.2% and 18.2%, respectively (Table 4).

Table 4 Incidence and severity of postoperative headache from April 9 to June 20, 2022(N = 420)
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Factors associated with postoperative headache

During the bivariate logistic analysis variables like, intraoperative hypertension, prolonged preoperative fasting, intraoperative hypotension, general anesthesia, female gender, both self and family history of prior headache were significantly associated with postoperative headache. However, in multivariate logistic analysis, female gender (AOR = 1.62, 95%CI = 1.03–2.53), intraoperative hypotension (AOR = 1.74, 95%CI = 1.06–2.88), general anesthesia (AOR = 1.96, 95%CI = 1.25–3.18), prior history of headache (AOR = 4.84, 95%CI = 2.40–9.74) and prolonged preoperative fasting (AOR = 2.28, 95%CI = 1.45–3.60) and caffeine consumption (AOR: 1.60, 95%CI = 1.03–2.54) were significantly associated with the postoperative headache (Table 5).

Accordingly, being female increases the risk of postoperative headache by 1.6 times as compared to being male (AOR = 1.62 95% CI = 1.03–2.53). Patients operated under general anesthesia were 1.96 times more likely to develop postoperative headache as compared to counterparts (AOR = 1.96, 95%CI = 1.25–3.18). The risk of developing postoperative headache in patients who consume caffeine was increased by 1.6 times as compared to non-consumers (AOR = 1.60, 95%CI = 1.03–2.54). Intraoperative hypotension increases the likelihood of postoperative headache by 1.7 times as compared to patients who had normal blood pressure during surgery (AOR = 1.74, 95%CI = 1.06–2.88). Patients who had prolonged preoperative fasting time had a two-fold increased risk of POH (AOR = 2.28, 95%CI = 1.45–3.60) and patients who had prior history of headache had a four-fold increased risk of developing postoperative headache (AOR = 4.84, 95%CI = 2.40–9.74) (Table 5).

Table 5 Factors associated with postoperative headache from April 9 to June 20, 2022(N = 420)
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Discussion

Postoperative headache is a complication that occurs shortly after anesthesia [1, 2].

According to our findings, more than half of our study participants experienced postoperative headache 228 (54.3%) (95% CI = 49.5–59.0).This finding is in line with a study which reported a 54% incidence of headache in postoperative patients [23].

However, a prospective cohort study conducted in Greece reported a lower incidence of postoperative headache (28.3%) [13]. The possible reason for this may be due to intraoperative anesthesia maintenance difference, they maintained with intravenous propofol but our maintenance was inhalational anesthetic drugs. The use of propofol reduces the incidence of postoperative headache as compared to conventional type of anesthesia [24,25,26]. Furthermore, clinical practice difference, demographic distribution of headache, differences in postoperative care, follow up and the access to symptomatic treatments might be the other possible reason for the different incidence of postoperative headache.

Similarly, a study done in China reported a lower incidence of postoperative headache(27.5%) as compared with our study [11]. This might be explained by clinical practice difference, differences in postoperative care, follow up and the access to symptomatic treatments and a difference in study design. In another follow-up study done in Brazil showed that high incidence of postoperative headache (91%) [27]. The difference may be due to the fact that their study was done on patients who are risky for developing postoperative headache since the procedure was craniotomy as compared to our study participants and also there may be a difference in age and gender, type of surgeries performed, endemic conditions, and even different prevalence of primary headache disorders in their area. Another study carried out to compare the effect of anesthesia technique on the incidence of postoperative headache among orthopedic surgical patients found a 44% incidence of POH [23]. This is also low as compared to our findings. The difference might be explained by the type of surgical procedure differences, differences in postoperative care, follow up and the access to symptomatic treatments.

In our study, the majority of patients (60%) developed postoperative headache during the first 12 h of postoperative period. This finding is consistent with the findings of a research which reported a maximum incidence of postoperative headache during the first 12 h after surgery [28]. This might be explained by active residual effect of anesthetic drugs exposes the patient to headache because the drugs need some times to be metabolized.

In our study, type of anesthesia, gender, intraoperative hypotension, previous history of headache, prolonged preoperative fasting and caffeine consumption were identified as independent risk factors for the development of postoperative headache.

The result of our study showed that patients operated under general anesthesia had an increased risk of postoperative headache when compared with patients operated under regional anesthesia. Our finding is supported by a study conducted to compare the incidence of postoperative headache using general anesthesia versus spinal versus combined general and regional anesthesia. It showed that higher incidence of postoperative headache in patients operated under general anesthesia [23]. This might be because of the physiologic disruption of central nervous system by general anesthesia medications. Similarly, a study conducted on ambulatory surgical patients to evaluate the incidence of postoperative complications and their relation with anesthetic techniques, found that the use of inhalational anesthetic agents were significantly associated with postoperative headache [29]. Our finding is also supported by existing evidences. Inhalational anesthetic agents including halothane and isoflurane are known causes of postoperative headache because of cerebral vasodilation [30]. So, patients who undergo surgery under general anesthesia may need regular perioperative assessment for headache and possible intervention.

Correspondingly, in the current study, we found a significant association between prolonged preoperative fasting hours and postoperative headache. Patients with prolonged preoperative fasting hours were more likely to develop postoperative headache. This finding is also supported by other studies [31, 32]. The reason behind might be explained by prolonged starvation may end up with intravascular volume depletion and hypoglycemia in turn blood flow to the brain also decreases and pressure sensitive brain vasculature began to develop pain. So, shortening the preoperative fasting may decrease fasting related headache disorders in the perioperative period.

Furthermore, the finding of our study showed that intraoperative hypotension is associated with postoperative headache. Our finding is supported by a study conducted in Greece [12]. Existing evidences also showed an association between headache and hypotension. The possible pathophysiology as explained by existing evidences is that, hypotension induces a reduction in cerebral blood flow and affects cerebral perfusion. finally, results in a significant mismatch of cerebral oxygen delivery and demand [33, 34]. So, improving perioperative cardiac function may help to decrease the occurrence of postoperative headache [35].

Furthermore, in our study, female gender was strongly associated with postoperative headache. This is also supported by many comparative studies conducted to compare the occurrence of postoperative complications between men and women [11, 13, 35, 36]. The possible explanation may be, since women have fluctuating hormones(estrogen, serotonin and progesterone) during their menstrual cycle they may experience headache and they are more likely to be affected by psychosocial factors. In addition, pain expression is more socially acceptable in women than men. So, women are more likely to report headache attacks [37, 38].

The other most important risk factor identified as a cause of postoperative headache was prior history of headache. In this study, patients with prior history of headache are more likely to develop postoperative headache. This finding is consistent with other research findings [13, 36, 39]. The association may be explained by endogenously formed substances in prior history of headache that are assumed to interact with intracranial nociception during disruption of brain physiology because of anesthesia. Among such substances, which may be elevated in patients’ plasma during headaches or which can induce headaches, are neuropeptides, in particular calcitonin gene-related peptide (CGRP), nitric oxide (NO) and its metabolites, and prostaglandin E2 (PGE2) these cause post operative headache easily on the other hand Headache attributable to disorders of homeostasis represents a diverse diagnostic category in which external (i.e., high-altitude) or internal (i.e., fasting) demands exceed homeostatic capacity, resulting in symptomatic headaches. Metabolic headaches, especially fasting headache, have been observed to be common in the general population. In many cases, a history of migraine is a risk factor, consistent with the hypothesis of an adaptive, evolutionary role of headache to warn against environmental and physiological threats. Because many exposures may also be interpreted as migraine triggers, some authors have considered certain disorders in this category to more accurately represent primary headache disorders. Nonetheless, these disorders not only represent important clinical entities, recognition of which may prevent medical morbidity, but also interesting exposure-response models to further our understanding regarding headache pathophysiology [40, 41].

Our study has revealed that the risk of postoperative headache in coffee consumers is high in comparison with non-consumers. Cessation of use of caffeine containing drinks after chronic exposure leads to withdrawal syndrome with headache as its dominant symptom [42]. The interruption of daily consumption of caffeine-containing beverages can cause headache and other symptoms within 8 h [43]. In contrast to our finding, a study found no association between postoperative headache and caffeine consumption [39]. The difference with our result may be due to the fact that this study was conducted on day case surgical patients with short follow up time. Caffeine is a commonly used Neuro stimulant that produces cerebral vasoconstriction by antagonizing adenosine receptors and its withdrawal results in cerebral vasodilation and the end result will be headache (61).

In addition, the enhanced recovery after surgery(ERAS) protocol recommends caffeine supplementation in chronic caffeine consumers to mitigate the development of postoperative headache and it is already part of a clinical practice at many institutions [21].

Although, history of smoking, history of alcohol, intraoperative hypertension, intraoperative hypercarbia, white blood cell count and albumin level are well known causes of postoperative headache, we did not find significant association with the outcome variable [13]. The difference may be due to the fact that we included few smokers and most patients had no baseline albumin level as well as less incidence of intraoperative hypertension was documented and we did not analyze the association between hypercarbia and postoperative headache because most patients were not monitored with Capnometry due to limited access to it.

Limitation and strength of the study

This study is the first of its kind both in the study area and in the country. So, we hope the study will provide a base line data regarding the incidence and associated factors of postoperative headache. We have also used adequate sample size and included diverse groups of surgical patients. However, this study is not without limitations. First, it is a single-centered study which might make generalizability difficult. Secondly, our primary end point was to determine the incidence of postoperative headache and also there might be a recall bias of headache since we started patient follow up at 6 h of post operative time. So, we did not evaluate the type of headache each patients had and some patients were asked for headache retrospectively, this may result in recall bias as well we did not evaluate the quality of pain to specific etiologies.

Conclusions and recommendation

According to the findings of our study, more than half of our study participants suffered from postoperative headache. Use of general anesthesia techniques, intraoperative hypotension, being female, consuming caffeine, prior history of headache and having prolonged preoperative fasting hours were significantly associated with postoperative headache and finally, based on our findings, we would like to recommend strict adherence of fasting guideline since it decreases the incidence of postoperative headache and preventing and managing intraoperative hypotension may also help to reduce the risk of postoperative headache. Patients who undergo surgery under general anesthesia, caffeine consumers, patients with prior history of headache and women may need regular perioperative assessment. These risk factors and the presence of headache need regular assessment in the perioperative period in order to offer analgesics and risk reduction strategies. We also recommend future researchers to conduct a research on the impact of postoperative headache on patient’s postoperative outcome. Since the problem is wide spread and understudied, more high level studies are recommended we hope there is a lot to discover.

Data availability

No datasets were generated or analysed during the current study.

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Acknowledgements

We would like to acknowledge our institution for the ethical clearance and support. Our gratitude also goes to the study participants for their volunteer participation. In addition, this research would not be reached in this stage without the effort of data collectors.

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Self funded.

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Authors and Affiliations

  1. Department of Anesthesia, School of Medicine, College of Medicine and Health sciences, Bahirdar University, Bahirdar, Ethiopia

    Sitotaw Tesfa Zegeye

  2. Department of Anesthesia, School of Medicine, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia

    Habtu Adane Aytolign, Zemenay Ayinie Mekonnen & Seid Adem Ahmed

Authors
  1. Sitotaw Tesfa Zegeye
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  2. Habtu Adane Aytolign
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  3. Zemenay Ayinie Mekonnen
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Contributions

S.A. and S. T. wrote the main manuscript text and H. A. and Z.A. prepared figures. All authors reviewed the manuscript.

Corresponding author

Correspondence to Seid Adem Ahmed.

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Ethics approval and consent to participate

Ethical approval was obtained from ethical review committee of college of medicine and health sciences, university of Gondar, with date and reference number of 25/3/2022 and Ref.No SOM/1404/2022, respectively. Signed informed consent was obtained from each participant after detailed disclosure.

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Not applicable, the article did not include any personal or any clinical detail of any participant.

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Zegeye, S.T., Aytolign, H.A., Mekonnen, Z.A. et al. Incidence and factors associated with postoperative headache among adult elective surgical patients at the university of gondar comprehensive specialized hospital, northwest Ethiopia, 2022: a prospective follow-up study. BMC Anesthesiol 25, 44 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12871-025-02910-9

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Keywords

BMC Anesthesiology

ISSN: 1471-2253

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