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

Nowacki, Andreas; Schöber, Martin; Nader, Lydia; Saryyeva, Assel; Nguyen, T. A. Khoa; Green, A L; Pollo, Claudio; Krauss, Joachim K.; Fontaine, Denys; Aziz, Tipu Z.

doi:10.1002/ana.25887

Cited by 31 publications

(22 citation statements)

References 49 publications

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“…This group found that in 40 patients in four different cohorts, mean reduction in headache frequency was 77% during a follow-up of 44 months, with an overall response rate of 75%. A map of brain region stimulation for therapeutic effect of DBS identified the midbrain ventral and retrorubral tegmentum as important sites [85]. This meta-analysis also reinforces the current view that DBS in the ventral tegmental area probably acts upon pain circuits involved in maintaining CH [36].…”

Section: Dbs For Cchsupporting

confidence: 77%

“…Recently, Nowacki and his team have published a meta-analysis [85] to present estimates and predictors of long-term pain relief based on the cohorts of patients undergoing DBS for CCH. This group found that in 40 patients in four different cohorts, mean reduction in headache frequency was 77% during a follow-up of 44 months, with an overall response rate of 75%.…”

Section: Dbs For Cchmentioning

confidence: 99%

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Medical Hypothesis: Deep Brain Stimulation for Intractable Migraine

Gazerani¹,

Cairns

2021

OBM Neurobiology

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Deep Brain Stimulation (DBS) has been introduced as an innovative treatment for several neurological disorders, including Parkinson’s disease, essential tremor, and dystonia and it has been proven effective in helping individuals affected by these disorders; hence, enhancing their quality of life. DBS has also been investigated for the treatment of cluster and other primary headaches. Electrodes are surgically implanted into brain structures, for example the posterior hypothalamus in case of cluster headache. Hypothalamic DBS has been successfully used to treat patients with cluster headache and short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT). In these headache conditions, DBS may reduce headache frequency by half, however, some side effects have also been reported that are mainly related to infection where the electrodes are placed, syncope, and diplopia. Hypothalamic DBS is proposed to modulate neuronal structures that are directly or indirectly involved in detection or transmission of painful stimuli or in the processing of this information. Reports of the use of DBS for chronic migraine are not found in the literature. This commentary explores the medical hypothesis that DBS could be considered as a therapeutic option for intractable chronic migraine. This hypothesis is based on the commonalities between cluster headache and migraine in terms of some shared symptoms, and potential overlap of underlying mechanisms. However, due to the absence of clinical evidence supporting the use of DBS in CM, the fact that disease-specific optimization of DBS parameters must be considered carefully, and considering the optimal CNS structures to target are currently unknown, it is concluded that this interventional and invasive technique should be avoided for CM for the present time.

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Section: Dbs For Cchsupporting

confidence: 77%

Section: Dbs For Cchmentioning

confidence: 99%

Medical Hypothesis: Deep Brain Stimulation for Intractable Migraine

Gazerani¹,

Cairns

2021

OBM Neurobiology

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“…Some CCH patients do not tolerate or respond to the currently used preventive drugs and are, therefore, classified as rCCH patients 5 . Non‐pharmacological therapeutic strategies have been tried over the last few decades to provide relief to these patients, including invasive occipital nerve stimulation, sphenopalatine ganglion stimulation, and deep brain stimulation 6‐9 . Recently, monoclonal antagonist antibodies targeting calcitonin gene‐related peptide have provided new hopes for the prevention of CH.…”

Section: Discussionmentioning

confidence: 99%

Ketamine‐Magnesium for Refractory Chronic Cluster Headache: A Case Series

et al. 2020

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Objectives To evaluate the safety and efficacy of ketamine‐magnesium combination to reduce attacks in a series of patients with refractory chronic cluster headache (rCCH). Background Refractory chronic cluster headache (CCH) is a rare but highly debilitating condition that needs new treatment options. A previous publication reported that a single infusion of ketamine‐magnesium combination was effective in 2 patients with rCCH. Methods The treatment was proposed to consecutive patients with rCCH seen in 2 French hospitals between November 2015 and February 2020 and who were resistant to at least 3 preventive treatments. They received a single ketamine infusion (0.5 mg/kg over 2 hours) combined with magnesium sulfate (3000 mg). The main outcome was a comparison of the number of daily attacks 2 weeks prior to the ketamine‐magnesium infusion and 1 week after (on days 7 and 8). The second outcome was the percentage of responders (patients with ≥50% reduction in the frequency of daily attacks). Safety was assessed by the recording of adverse events during infusion. Descriptive statistics are presented as mean ± standard deviation. Results Seventeen patients (14 men), with an age of 35.2 ± 8.1 years, were included. They presented with CCH for 6.6 ± 4.3 years. The number of daily attacks decreased from 4.3 ± 2.4 before treatment to 1.3 ± 1.0 after treatment (difference: −3.1 (95% CI: −4.5 to −1.6), P < .001). Seventy six percent (13/17) were responders. Transient and mild sedation was reported by 7/17 patients (41.2%). Conclusions The ketamine‐magnesium combination seems an effective and well‐tolerated therapy for rCCH. Placebo‐controlled studies should be conducted to further confirm these findings.

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“…Finally, the positive effect on attack frequency of continuous hypothalamic stimulation may support the idea of hypothalamic involvement [126]. However, there are persisting doubts about the precise structures that stimulation needs to target to achieve therapeutic success [127,128].…”

Section: The Hypothalamusmentioning

confidence: 91%

Cluster Headache Pathophysiology—A Disorder of Network Excitability?

Pohl

Sándor

Michels

et al. 2021

CTN

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Patients’ accounts of cluster headache attacks, ictal restlessness, and electrophysiological studies suggest that the pathophysiology involves Aδ-fibre nociceptors and the network processing their input. Continuous activity of the trigeminal autonomic reflex throughout the in-bout period results in central sensitization of these networks in many patients. It is likely that several factors force circadian rhythmicity upon the disease. In addition to sensitization, circadian changes in pain perception and autonomic innervation might influence the excitability of the trigeminal cervical complex. Summation of several factors influencing pain perception might render neurons vulnerable to spontaneous depolarization, particularly at the beginning of rapid drops of the pain threshold (“summation headache”). In light of studies suggesting an impairment of short-term synaptic plasticity in CH patients, we suggest that the physiologic basis of CH attacks might be network overactivity—similarly to epileptic seizures. Case reports documenting cluster-like attacks support the idea of distinct factors being transiently able to induce attacks and being relevant in the pathophysiology of the disorder. A sustained and recurring proneness to attacks likely requires changes in the activity of other structures among which the hypothalamus is the most probable candidate.

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

Cited by 31 publications

References 49 publications

Medical Hypothesis: Deep Brain Stimulation for Intractable Migraine

Medical Hypothesis: Deep Brain Stimulation for Intractable Migraine

Ketamine‐Magnesium for Refractory Chronic Cluster Headache: A Case Series

Cluster Headache Pathophysiology—A Disorder of Network Excitability?

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