Deep Brain Stimulation for Intractable Chronic Cluster Headache: Proposals for Patient Selection

Cephalalgia ◽  
2004 ◽  
Vol 24 (11) ◽  
pp. 934-937 ◽  
Author(s):  
M Leone ◽  
A May ◽  
A Franzini ◽  
G Broggi ◽  
D Dodick ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Deep Brain Stimulation ◽  
Cluster Headache ◽  
Brain Stimulation ◽  
Brain Area ◽  
Chronic Cluster Headache ◽  
Primary Headaches ◽  
Positron Emission ◽  
Academic Medical ◽  
Deep Brain

Cluster headache is the most severe of the primary headaches. Positron emission tomography and functional MRI studies have shown that the ipsilateral posterior hypothalamus is activated during cluster headache attacks and is structurally asymmetric in these patients. These changes are highly specific for the condition and suggest that the cluster headache generator may be located in that brain area; they further suggest that electrical stimulation of that region might produce clinical improvement in chronic cluster headache sufferers refractory to medical therapy. In five patients with severe intractable chronic cluster headache, hypothalamic electrical stimulation produced complete and long-term pain relief with no relevant side-effects. We therefore consider it essential to propose criteria for selecting chronic cluster headache patients for hypothalamic deep brain stimulation before this procedure is undertaken at other academic medical centres.

Hypothalamic Deep-Brain Stimulation: Target and Potential Mechanism for the Treatment of Cluster Headache

Cephalalgia ◽  
2008 ◽  
Vol 28 (7) ◽  
pp. 799-803 ◽  
Author(s):  
A May
Keyword(s):  
Deep Brain Stimulation ◽  
Cluster Headache ◽  
Brain Stimulation ◽  
Antinociceptive Effect ◽  
Primary Headaches ◽  
Imaging Data ◽  
Pain Transmission ◽  
Positron Emission ◽  
Deep Brain

Recently, functional imaging data have underscored the crucial role of the hypothalamus in trigemino-autonomic headaches, a group of severe primary headaches. This prompted the application of hypothalamic deep-brain stimulation (DBS), with the intention to preventing cluster headache (CH) attacks in selected severe therapy-refractory cases. To date, a total of 50 operated intractable CH patients, one patient with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing and three with atypical facial pain, have been reported. However, it is not apparent why the spontaneous bursts of activation in the inferior posterior hypothalamus result in excruciating head pain, whereas continuous electrical stimulation of the identical area is able to prevent these attacks. Recently, this issue has been addressed by examining 10 operated chronic CH patients, using H215O-positron emission tomography and alternately switching the hypothalamic stimulator on and off. The stimulation-induced activation in the ipsilateral posterior inferior hypothalamic grey (the site of the stimulator tip) as well as activation and de-activation in several cerebral structures belonging to neuronal circuits usually activated in pain transmission. These data argue against an unspecific antinociceptive effect or pure inhibition of hypothalamic activity as the mode of action of hypothalamic DBS and suggest functional modulation of the pain-processing network.

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

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 ◽  
Chronic Cluster Headache ◽  
Deep Brain

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

Neurosurgery ◽  
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 ◽  
Chronic Cluster Headache ◽  
Posterior Hypothalamus ◽  
Deep Brain ◽  
Stimulation Of

Deep Brain Stimulation for Chronic Cluster Headache: A Review

2018 ◽  
Vol 22 (4) ◽  
pp. 388-397 ◽  
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 ◽  
Chronic Cluster Headache ◽  
Deep Brain

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

Cephalalgia ◽  
2008 ◽  
Vol 28 (3) ◽  
pp. 285-295 ◽  
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 ◽  
Chronic Cluster Headache ◽  
Posterior Hypothalamus ◽  
Attack Frequency ◽  
Deep Brain

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.

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

Cephalalgia ◽  
2012 ◽  
Vol 33 (2) ◽  
pp. 136-138 ◽  
Author(s):  
Giuseppe Messina ◽  
Michele Rizzi ◽  
Roberto Cordella ◽  
Augusto Caraceni ◽  
Ernesto Zecca ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Cluster Headache ◽  
Brain Stimulation ◽  
Soft Tissues ◽  
Chronic Cluster Headache ◽  
Successful Outcome ◽  
The Right ◽  
Fondazione Irccs ◽  
Deep Brain

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.

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

Cephalalgia ◽  
2019 ◽  
Vol 39 (9) ◽  
pp. 1099-1110 ◽  
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 ◽  
Chronic Cluster Headache ◽  
Headache Frequency ◽  
Deep Brain

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.

Feasibility of simultaneous vagal nerve and deep brain stimulation in chronic cluster headache: case report and considerations

2009 ◽  
Vol 30 (S1) ◽  
pp. 137-139 ◽  
Author(s):  
Angelo Franzini ◽  
G. Messina ◽  
Massimo Leone ◽  
A. Proietti Cecchini ◽  
Giovanni Broggi ◽  
...  
Keyword(s):  
Case Report ◽  
Deep Brain Stimulation ◽  
Cluster Headache ◽  
Brain Stimulation ◽  
Chronic Cluster Headache ◽  
Vagal Nerve ◽  
Deep Brain

Deep Brain Stimulation for Chronic Cluster Headache: Meta‐Analysis of Individual Patient Data

2020 ◽  
Vol 88 (5) ◽  
pp. 956-969
Author(s):  
Andreas Nowacki ◽  
Martin Schober ◽  
Lydia Nader ◽  
Assel Saryyeva ◽  
Thuy‐Anh Khoa Nguyen ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Cluster Headache ◽  
Brain Stimulation ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Chronic Cluster Headache ◽  
Patient Data ◽  
Deep Brain

scholarly journals Deep brain stimulation of posterior hypothalamic area for cluster headache

2018 ◽  
Vol 1 ◽  
pp. 251581631877133 ◽  
Author(s):  
Antti Huotarinen ◽  
Mikko Kallela ◽  
Ville Artto ◽  
Aki Laakso ◽  
Riku Kivisaari
Keyword(s):  
Deep Brain Stimulation ◽  
Cluster Headache ◽  
Brain Stimulation ◽  
Treatment Effect ◽  
Chronic Cluster Headache ◽  
University Hospital ◽  
Hypothalamic Area ◽  
Headache Patients ◽  
Deep Brain ◽  
Stimulation Of

Background: Deep brain stimulation of the posterior hypothalamic area is one of the neuromodulation treatments used for chronic cluster headache, but the number of published patients remains low. Aim: The aim of this article was to present the retrospective results of 12 consecutive chronic cluster headache patients treated with deep brain stimulation at Helsinki University Hospital. Materials and Methods: All chronic cluster headache patients treated with deep brain stimulation between 2004 and 2012 were included in the study. Patients were interviewed and their hospital files analyzed. Treatment effect was classified as good, partial, or no effect. Results: Of the 12 patients, four had a good treatment effect, five had partial, and three had no effect of deep brain stimulation. In contrast to previous studies, our patients reported an almost immediate benefit after the onset of stimulation. Conclusions: Deep brain stimulation provides clinically meaningful benefit to a subgroup of chronic cluster headache patients.

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