Deep Brain Stimulation for Chronic Cluster Headache: A Review

Vyas, Daivik B.; Ho, Allen L.; Dadey, David; Pendharkar, Arjun V; Sussman, Eric S; Cowan, Robert P.; Halpern, Casey H.

doi:10.1111/ner.12869

Cited by 34 publications

(19 citation statements)

References 55 publications

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“…Some patients even attempt to end their life by suicide. 5 Invasive hypothalamic stimulation has shown promis ing efficacy in small studies without a control group (these have been reviewed elsewhere), 6,7 but was sometimes associated with fatal complications. 8 Moreover, although effective in migraine 9 and episodic cluster headache, 10 the monoclonal anti bodies to calcitoningenerelated peptide or its receptor were not effective in chronic cluster head ache, 11,12 underscoring the high unmet need for effective preventive treatment of this devastating disease.…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of occipital nerve stimulation for attack prevention in medically intractable chronic cluster headache (ICON): a randomised, double-blind, multicentre, phase 3, electrical dose-controlled trial

Ferrari

Wilbrink

Coo

et al. 2021

The Lancet Neurology

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Section: Introductionmentioning

confidence: 99%

Safety and efficacy of occipital nerve stimulation for attack prevention in medically intractable chronic cluster headache (ICON): a randomised, double-blind, multicentre, phase 3, electrical dose-controlled trial

Ferrari

Wilbrink

Coo

et al. 2021

The Lancet Neurology

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“…The ONS is one of the safest and most attractive choices for patients suffering drCCH, given the risk of serious complications described after other advanced therapeutic interventions. For example, deep-brain stimulation (DBS) may cause the development of contralateral cluster headache, seizure due to electrode repositioning after trauma, deep electrode infection leading to sepsis, death and ventricular hemorrhage [ 7 ]. This therapy is effective at targeting peripheral structures implied in CH pathophysiology, reducing the frequency and intensity of attacks through the inhibition of nociceptive activity in c-fibers and a-delta fibers.…”

Section: Introductionmentioning

confidence: 99%

Occipital Nerve Stimulation for Pain Modulation in Drug-Resistant Chronic Cluster Headache

et al. 2021

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Occipital nerve stimulation (ONS) is a surgical treatment proposed for drug-resistant chronic cluster headache (drCCH). Long-term series assessing its efficacy are scarce. We designed a retrospective observational study with consecutive sampling, evaluating the follow-up of 17 drCCH patients who underwent ONS. Our main endpoint was the reduction the rate of attacks per week. We also evaluated the pain intensity through the Visual Analogue Scale (VAS), patient overall perceived improvement and decrease in oral medication intake. After a median follow-up of 6.0 years (4.5–9.0), patients decreased from a median of 30 weekly attacks to 22.5 (5.6–37.5, p = 0.012), 7.5 at 1 year (p = 0.006) and 15.0 at the end of follow-up (p = 0.041). The VAS decreased from a median of 10.0 to 8.0 (p = 0.011) at three months, to 7.0 (p = 0.008) at twelve months and 7.0 (p = 0.003) at the end of the follow-up. A total of 23.5% had an overall perceived improvement of ≥ 70% at 3 months, 41.2% at 1 year and 27.8% at the end of follow-up. Reducing prophylactic oral medication was possible in 76,5% and it was stopped in 17.7%. Triptan use decreased in all the responder patients and 17.7% stopped its intake. A total of 41.2% presented mild adverse events. In conclusion, our long-term experience suggests that ONS could be an interesting option for drCCH-selected patients, as it is a beneficial and minimally invasive procedure with no serious adverse events.

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“…Transient visual disturbances, diplopia, vertigo, nausea, euphoria, bradycardia, and appetite changes have been reported as the main side effects following DBS of the posterior hypothalamus. Serious events have also been documented such as intracerebral hemorrhage, hardware infection, transient loss of consciousness, and skin erosion or hardware malfunction [107]. Lead fracture is another common complication.…”

Section: Safety and Patient Selection For Dbsmentioning

confidence: 99%

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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Deep Brain Stimulation for Chronic Cluster Headache: A Review

Cited by 34 publications

References 55 publications

Safety and efficacy of occipital nerve stimulation for attack prevention in medically intractable chronic cluster headache (ICON): a randomised, double-blind, multicentre, phase 3, electrical dose-controlled trial

Safety and efficacy of occipital nerve stimulation for attack prevention in medically intractable chronic cluster headache (ICON): a randomised, double-blind, multicentre, phase 3, electrical dose-controlled trial

Occipital Nerve Stimulation for Pain Modulation in Drug-Resistant Chronic Cluster Headache

Medical Hypothesis: Deep Brain Stimulation for Intractable Migraine

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