Abstract
Cluster headache (CH) is a primary headache with excruciatingly painful attacks that are strictly unilateral. About 10% of cases experience no significant remission, and about 15% of these do not respond to medication, so surgery is considered. Neuroimaging studies show that the posterior inferior hypothalamus is activated during CH attacks and is plausibly the CH generator. We report on 16 chronic CH patients, with headaches refractory to all medication, who received long-term hypothalamic stimulation following electrode implant to the posterior inferior hypothalamus. After a mean follow-up of 23 months, a persistent pain-free to almost pain-free state was achieved in 13/16 patients (15/18 implants; 83.3%) a mean of 42 days (range 1-86 days) after monopolar stimulation initiation. Ten patients (11 implants) are completely pain-free. A common side effect was transient diplopia, which limited stimulation amplitude. In one patient, a small non-symptomatic haemorrhage into the 3rd ventricle occurred following implant, but regressed 24 h later. Persistent side effects are absent except in one patient with bilateral stimulation, in whom stimulation was stopped to resolve vertigo and worsened bradycardia, but was resumed later without further problems. Hypothalamic stimulation is an effective, safe and well tolerated treatment for chronic drug-refractory CH. It appears as a valid alternative to destructive surgical modalities, and has the additional advantage of being reversible.
| Original language | English |
|---|---|
| Journal | Neurological Sciences |
| Volume | 28 |
| Issue number | SUPPL. 2 |
| DOIs | |
| Publication status | Published - May 2007 |
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Keywords
- Cluster headache
- Deep brain stimulation
- SUNCT
- Surgery
- Therapy
ASJC Scopus subject areas
- Neuroscience(all)
- Clinical Neurology
Cite this
Deep brain stimulation in craniofacial pain : Seven years' experience. / Bussone, G.; Franzini, A.; Proietti Cecchini, A.; Mea, E.; Curone, M.; Tullo, V.; Broggi, G.; Casucci, G.; Bonavita, V.; Leone, M.
In: Neurological Sciences, Vol. 28, No. SUPPL. 2, 05.2007.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Deep brain stimulation in craniofacial pain
T2 - Seven years' experience
AU - Bussone, G.
AU - Franzini, A.
AU - Proietti Cecchini, A.
AU - Mea, E.
AU - Curone, M.
AU - Tullo, V.
AU - Broggi, G.
AU - Casucci, G.
AU - Bonavita, V.
AU - Leone, M.
PY - 2007/5
Y1 - 2007/5
N2 - Cluster headache (CH) is a primary headache with excruciatingly painful attacks that are strictly unilateral. About 10% of cases experience no significant remission, and about 15% of these do not respond to medication, so surgery is considered. Neuroimaging studies show that the posterior inferior hypothalamus is activated during CH attacks and is plausibly the CH generator. We report on 16 chronic CH patients, with headaches refractory to all medication, who received long-term hypothalamic stimulation following electrode implant to the posterior inferior hypothalamus. After a mean follow-up of 23 months, a persistent pain-free to almost pain-free state was achieved in 13/16 patients (15/18 implants; 83.3%) a mean of 42 days (range 1-86 days) after monopolar stimulation initiation. Ten patients (11 implants) are completely pain-free. A common side effect was transient diplopia, which limited stimulation amplitude. In one patient, a small non-symptomatic haemorrhage into the 3rd ventricle occurred following implant, but regressed 24 h later. Persistent side effects are absent except in one patient with bilateral stimulation, in whom stimulation was stopped to resolve vertigo and worsened bradycardia, but was resumed later without further problems. Hypothalamic stimulation is an effective, safe and well tolerated treatment for chronic drug-refractory CH. It appears as a valid alternative to destructive surgical modalities, and has the additional advantage of being reversible.
AB - Cluster headache (CH) is a primary headache with excruciatingly painful attacks that are strictly unilateral. About 10% of cases experience no significant remission, and about 15% of these do not respond to medication, so surgery is considered. Neuroimaging studies show that the posterior inferior hypothalamus is activated during CH attacks and is plausibly the CH generator. We report on 16 chronic CH patients, with headaches refractory to all medication, who received long-term hypothalamic stimulation following electrode implant to the posterior inferior hypothalamus. After a mean follow-up of 23 months, a persistent pain-free to almost pain-free state was achieved in 13/16 patients (15/18 implants; 83.3%) a mean of 42 days (range 1-86 days) after monopolar stimulation initiation. Ten patients (11 implants) are completely pain-free. A common side effect was transient diplopia, which limited stimulation amplitude. In one patient, a small non-symptomatic haemorrhage into the 3rd ventricle occurred following implant, but regressed 24 h later. Persistent side effects are absent except in one patient with bilateral stimulation, in whom stimulation was stopped to resolve vertigo and worsened bradycardia, but was resumed later without further problems. Hypothalamic stimulation is an effective, safe and well tolerated treatment for chronic drug-refractory CH. It appears as a valid alternative to destructive surgical modalities, and has the additional advantage of being reversible.
KW - Cluster headache
KW - Deep brain stimulation
KW - SUNCT
KW - Surgery
KW - Therapy
UR - http://www.scopus.com/inward/record.url?scp=34249284470&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34249284470&partnerID=8YFLogxK
U2 - 10.1007/s10072-007-0768-2
DO - 10.1007/s10072-007-0768-2
M3 - Article
C2 - 17508162
AN - SCOPUS:34249284470
VL - 28
JO - Neurological Sciences
JF - Neurological Sciences
SN - 1590-1874
IS - SUPPL. 2
ER -