Cluster Headache

Posterior Hypothalamus ◽

Nerve Blocks ◽

Autonomic Symptoms ◽

Occipital Nerve ◽

Trigeminal Autonomic Cephalgia

Cluster headache, a trigeminal autonomic cephalgia, is a syndrome involving unilateral head pain associated with autonomic symptoms. The diagnosis is clinical. The pathophysiology of cluster headache is unknown. It is believed to involve the trigeminal nerve and ganglion, with autonomic dysfunction and vascular irritability. Initial treatment is with parenteral triptans and inhaled oxygen. Preventive agents include topiramate, verapamil, and lithium. Occipital nerve blocks and stimulation have been effective in small studies. Surgery is limited to those patients that have persistent, chronic cluster headache with a minimum of three attacks per week, despite treatment with at least three preventative agents. Deep brain stimulation of the posterior hypothalamus has been shown to be effective in the treatment of chronic cluster headache.

200 The Treatment of Chronic Cluster Headache With Deep Brain Stimulation of the Posterior Hypothalamus

Neurosurgery ◽

10.1093/neuros/nyy303.200 ◽

2018 ◽

Vol 65 (CN_suppl_1) ◽

pp. 115-115

Author(s):

Nilson N. Mendes Neto ◽

Jessika Thais da Silva Maia ◽

Juliano Jose da Silva ◽

Sergio Adrian Fernandes Dantas ◽

Marcelo Rodrigues Zacarkim ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Cluster Headache ◽

Brain Stimulation ◽

Posterior Hypothalamus ◽

Deep Brain ◽

Stimulation Of

Hypothalamic Deep Brain Stimulation for Cluster Headache: Experience From a New Multicase Series

Cephalalgia ◽

10.1111/j.1468-2982.2007.01531.x ◽

2008 ◽

Vol 28 (3) ◽

pp. 285-295 ◽

Cited By ~ 122

Author(s):

T Bartsch ◽

MO Pinsker ◽

D Rasche ◽

T Kinfe ◽

F Hertel ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Cluster Headache ◽

Brain Stimulation ◽

Discharge Rate ◽

Therapeutic Option ◽

Case Series ◽

Posterior Hypothalamus ◽

Attack Frequency ◽

Deep brain stimulation (DBS) of the posterior hypothalamus was found to be effective in the treatment of drug-resistant chronic cluster headache. We report the results of a multicentre case series of six patients with chronic cluster headache in whom a DBS in the posterior hypothalamus was performed. Electrodes were implanted stereotactically in the ipsilateral posterior hypothalamus according to published coordinates 2 mm lateral, 3 mm posterior and 5 mm inferior referenced to the mid-AC-PC line. Microelectrode recordings at the target revealed single unit activity with a mean discharge rate of 17 Hz (range 13-35 Hz, n = 4). Out of six patients, four showed a profound decrease of their attack frequency and pain intensity on the visual analogue scale during the first 6 months. Of these, one patient was attack free for 6 months under neurostimulation before returning to the baseline which led to abortion of the DBS. Two patients had experienced only a marginal, non-significant decrease within the first weeks under neurostimulation before returning to their former attack frequency. After a mean follow-up of 17 months, three patients are almost completely attack free, whereas three patients can be considered as treatment failures. The stimulation was well tolerated and stimulation-related side-effects were not observed on long term. DBS of the posterior inferior hypothalamus is an effective therapeutic option in a subset of patients. Future controlled multi-centre trials will need to confirm this open-label experience and should help to better define predictive factors for non-responders.

Trigeminal autonomic cephalalgias II: deep-brain stimulation of the posterior hypothalamus for chronic cluster headache

Surgery of the Autonomic Nervous System ◽

10.1093/med/9780199686407.003.0012 ◽

2016 ◽

pp. 193-204

Author(s):

Giuseppe Messina ◽

Roberto Cordella ◽

Michele Rizzi ◽

Massimo Leone ◽

Angelo Franzini

Keyword(s):

Deep Brain Stimulation ◽

Cluster Headache ◽

Brain Stimulation ◽

Posterior Hypothalamus ◽

Trigeminal Autonomic Cephalalgias ◽

Deep Brain ◽

Stimulation Of

Deep Brain Stimulation of the Posterior Hypothalamus in Chronic Cluster Headache

Neuromodulation ◽

10.1016/b978-0-12-374248-3.00040-9 ◽

2009 ◽

pp. 509-513

Author(s):

Angelo Franzini ◽

Giuseppe Messina ◽

Massimo Leone ◽

Gennaro Bussone ◽

Carlo Marras ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Cluster Headache ◽

Brain Stimulation ◽

Posterior Hypothalamus ◽

Deep Brain ◽

Stimulation Of

Deep Brain Stimulation for Intractable Chronic Cluster Headache: Results of Neuroimaging and Neurovegetative Assessment

Neuromodulation Technology at the Neural Interface ◽

10.1046/j.1525-1403.2003.03027_21.x ◽

2003 ◽

Vol 6 (3) ◽

pp. 206-206

Author(s):

Angelo Franzini ◽

Giovanni Broggi ◽

Gennaro Bussone ◽

Paolo Ferroli ◽

Massimo Leone ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Cluster Headache ◽

Brain Stimulation ◽

Deep Brain Stimulation for Chronic Cluster Headache: A Review

Neuromodulation Technology at the Neural Interface ◽

10.1111/ner.12869 ◽

2018 ◽

Vol 22 (4) ◽

pp. 388-397 ◽

Cited By ~ 8

Author(s):

Daivik B. Vyas ◽

Allen L. Ho ◽

David Y. Dadey ◽

Arjun V. Pendharkar ◽

Eric S. Sussman ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Cluster Headache ◽

Brain Stimulation ◽

Secondary chronic cluster headache treated by posterior hypothalamic deep brain stimulation: First reported case

Cephalalgia ◽

10.1177/0333102412468675 ◽

2012 ◽

Vol 33 (2) ◽

pp. 136-138 ◽

Cited By ~ 15

Author(s):

Giuseppe Messina ◽

Michele Rizzi ◽

Roberto Cordella ◽

Augusto Caraceni ◽

Ernesto Zecca ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Cluster Headache ◽

Brain Stimulation ◽

Soft Tissues ◽

Successful Outcome ◽

The Right ◽

Fondazione Irccs ◽

Introduction Deep brain stimulation (DBS) of the posterior hypothalamus (pHyp) has been reported as an effective treatment for primary, drug-refractory and chronic cluster headache (CCH). We here describe the use of such a procedure for the treatment of secondary CCH due to a neoplasm affecting the soft tissues of the right hemiface. Methods A 27-year-old man affected by infiltrating angiomyolipoma of the right hemiface who subsequently developed drug refractory homolateral CCH underwent DBS of the right pHyp region at the Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta. Results After surgery, the patient presented a significant reduction in frequency of pain bouts. However, because of a subsequent infection, the entire system was removed. After re-implantation of the system, successful outcome was observed at 2 years follow-up. Discussion This brief report shows the feasibility of pHyp DBS in secondary drug-refractory CCH syndromes; future reports are needed in order to confirm our positive result.

Occipital nerve stimulation and deep brain stimulation for refractory cluster headache: a prospective analysis of efficacy over time

Journal of Neurosurgery ◽

10.3171/2019.11.jns192042 ◽

2020 ◽

pp. 1-8

Author(s):

Juan Ángel Aibar-Durán ◽

María Jesús Álvarez Holzapfel ◽

Rodrigo Rodríguez Rodríguez ◽

Robert Belvis Nieto ◽

Carles Roig Arnall ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Cluster Headache ◽

Clinical Response ◽

Brain Stimulation ◽

Nerve Stimulation ◽

Occipital Nerve Stimulation ◽

Occipital Nerve ◽

Over Time ◽

OBJECTIVEOccipital nerve stimulation (ONS) and deep brain stimulation (DBS) are widely used surgical treatments for chronic refractory cluster headache (CH). However, there is little literature regarding long-term follow-up of these treatments.METHODSThe authors describe two prospective cohorts of patients with refractory CH treated with ONS and DBS and compare preoperative to postoperative status at 6 and 12 months after the surgery and at final follow-up. Efficacy analysis using objective and subjective variables is reported, as well as medication reduction and complications.RESULTSThe ONS group consisted of 13 men and 4 women, with a median age of 44 years (range 31–61 years). The median number of attacks per week (NAw) before surgery was 28 (range 7–70), and the median follow-up duration was 48 months. The DBS group comprised 5 men and 2 women, with a median age of 50 years (range 29–64 years). The median NAw before surgery was 56 (range 14–140), and the median follow-up was 36 months. The NAw and visual analog scale score were significantly reduced for the ONS and DBS groups after surgery. However, while all the patients from the DBS group were considered responders at final follow-up, with more than 85% being satisfied with the treatment, approximately 29% of initial responders to ONS became resistant by the final follow-up (p = 0.0253).CONCLUSIONSONS is initially effective as a treatment for refractory CH, although a trend toward loss of efficacy was observed. No clear predictors of good clinical response were found in the present study. Conversely, DBS appears to be effective and provide a more stable clinical response over time with an acceptable rate of surgical complications.

Ventral tegmental area deep brain stimulation for chronic cluster headache: Effects on cognition, mood, pain report behaviour and quality of life

Cephalalgia ◽

10.1177/0333102419839957 ◽

2019 ◽

Vol 39 (9) ◽

pp. 1099-1110 ◽

Cited By ~ 5

Author(s):

Davide Cappon ◽

Agata Ryterska ◽

Susie Lagrata ◽

Sarah Miller ◽

Harith Akram ◽

...

Keyword(s):

Quality Of Life ◽

Deep Brain Stimulation ◽

Cluster Headache ◽

Ventral Tegmental Area ◽

Brain Stimulation ◽

Rating Scale ◽

Headache Frequency ◽

Background Deep brain stimulation in the ventral tegmental area (VTA-DBS) has provided remarkable therapeutic benefits in decreasing headache frequency and severity in patients with medically refractory chronic cluster headache (CH). However, to date the effects of VTA-DBS on cognition, mood and quality of life have not been examined in detail. Methods The aim of the present study was to do so in a case series of 18 consecutive patients with cluster headache who underwent implantation of deep brain stimulation electrodes in the ventral tegmental area. The patients were evaluated preoperatively and after a mean of 14 months of VTA-DBS on tests of global cognition (Mini Mental State Examination), intelligence (Wechsler Abbreviated Scale of Intelligence), verbal memory (California Verbal Learning Test-II), executive function (Delis–Kaplan Executive Function System), and attention (Paced Auditory Serial Addition Test). Depression (Beck Depression Inventory and Hospital Anxiety and Depression Rating Scale-D), anxiety (Hospital Anxiety and Depression Rating Scale-A), apathy (Starkstein Apathy Scale), and hopelessness (Beck Hopelessness Scale) were also assessed. Subjective pain experience (McGill Pain Questionnaire), behaviour (Pain Behaviour Checklist) and quality of life (Short Form-36) were also evaluated at the same time points. Results VTA-DBS resulted in significant improvement of headache frequency (from a mean of five to two attacks daily, p < .001) and severity (from mean Verbal Rating Scale [VRS] of 10 to 7, p < .001) which was associated with significant reduction of anxiety (from mean HADS-A of 11.94 to 8.00, p < .001) and help-seeking behaviours (from mean PBC of 4.00 to 2.61, p < .001). VTA-DBS did not produce any significant change to any tests of cognitive function and any other outcome measures (BDI, HADS-D, SAS, BHS, McGill Pain Questionnaire, Short Form-36). Conclusion We confirm the efficacy of VTA-DBS in the treatment of medically refractory chronic cluster headache. The reduction of headache frequency and severity was associated with a significant reduction of anxiety. Furthermore, the result suggests that VTA-DBS for chronic cluster headache improves pain-related help-seeking behaviours and does not produce any change in cognition.