Abstract
This chapter focuses on the use of deep brain stimulation (DBS) of the posterior hypothalamus for treating chronic cluster headache (CCH). Physiopathological data on the etiology of cluster headaches point to the hypothalamus as a crucial site for the development of the disease. The diagnosis of CCH must be precise and supported by the headache classification criteria stated by the Headache Classification Committee of the International Headache Society in 2004. To avoid bias in patient selection, a multidisciplinary team approach including headache neurologists, psychiatrists, and headache dedicated Operative Units is recommended. About 30% of CCH patients may have significant improvement after peripheral neuromodulation procedures (GON), suggesting the existence of different subtypes of patients in the same diagnostic category. In some CCH patients, the peripheral component may contribute more to the genesis of the pain than the central components. The application of DBS in CCH patients is well tolerated and results in significant reduction of pain bouts. Transient, reversible diplopia is the main stimulation-related side effect, which limits the use of higher amplitudes for chronic stimulation. Currently, the collective experience from the literature suggests that 50-60% of patients respond to DBS. As a result of stimulation, most patients' lives gradually returns to normal and most resumes work. Further refinement of targeting and patient selection is expected to improve the success rate of pHyp stimulation in CCH patients. The cost of the procedure is largely compensated by one year of pain remission even if the disease cannot be cured by DBS.
| Original language | English |
|---|---|
| Title of host publication | Neuromodulation |
| Publisher | Elsevier Ltd |
| Pages | 509-513 |
| Number of pages | 5 |
| Volume | 1 |
| ISBN (Print) | 9780123742483 |
| DOIs | |
| Publication status | Published - 2009 |
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ASJC Scopus subject areas
- Neuroscience(all)
Cite this
Deep Brain Stimulation of the Posterior Hypothalamus in Chronic Cluster Headache. / Franzini, Angelo; Messina, Giuseppe; Leone, Massimo; Bussone, Gennaro; Marras, Carlo; Tringali, Giovenni; Broggi, Giovanni.
Neuromodulation. Vol. 1 Elsevier Ltd, 2009. p. 509-513.Research output: Chapter in Book/Report/Conference proceeding › Chapter
}
TY - CHAP
T1 - Deep Brain Stimulation of the Posterior Hypothalamus in Chronic Cluster Headache
AU - Franzini, Angelo
AU - Messina, Giuseppe
AU - Leone, Massimo
AU - Bussone, Gennaro
AU - Marras, Carlo
AU - Tringali, Giovenni
AU - Broggi, Giovanni
PY - 2009
Y1 - 2009
N2 - This chapter focuses on the use of deep brain stimulation (DBS) of the posterior hypothalamus for treating chronic cluster headache (CCH). Physiopathological data on the etiology of cluster headaches point to the hypothalamus as a crucial site for the development of the disease. The diagnosis of CCH must be precise and supported by the headache classification criteria stated by the Headache Classification Committee of the International Headache Society in 2004. To avoid bias in patient selection, a multidisciplinary team approach including headache neurologists, psychiatrists, and headache dedicated Operative Units is recommended. About 30% of CCH patients may have significant improvement after peripheral neuromodulation procedures (GON), suggesting the existence of different subtypes of patients in the same diagnostic category. In some CCH patients, the peripheral component may contribute more to the genesis of the pain than the central components. The application of DBS in CCH patients is well tolerated and results in significant reduction of pain bouts. Transient, reversible diplopia is the main stimulation-related side effect, which limits the use of higher amplitudes for chronic stimulation. Currently, the collective experience from the literature suggests that 50-60% of patients respond to DBS. As a result of stimulation, most patients' lives gradually returns to normal and most resumes work. Further refinement of targeting and patient selection is expected to improve the success rate of pHyp stimulation in CCH patients. The cost of the procedure is largely compensated by one year of pain remission even if the disease cannot be cured by DBS.
AB - This chapter focuses on the use of deep brain stimulation (DBS) of the posterior hypothalamus for treating chronic cluster headache (CCH). Physiopathological data on the etiology of cluster headaches point to the hypothalamus as a crucial site for the development of the disease. The diagnosis of CCH must be precise and supported by the headache classification criteria stated by the Headache Classification Committee of the International Headache Society in 2004. To avoid bias in patient selection, a multidisciplinary team approach including headache neurologists, psychiatrists, and headache dedicated Operative Units is recommended. About 30% of CCH patients may have significant improvement after peripheral neuromodulation procedures (GON), suggesting the existence of different subtypes of patients in the same diagnostic category. In some CCH patients, the peripheral component may contribute more to the genesis of the pain than the central components. The application of DBS in CCH patients is well tolerated and results in significant reduction of pain bouts. Transient, reversible diplopia is the main stimulation-related side effect, which limits the use of higher amplitudes for chronic stimulation. Currently, the collective experience from the literature suggests that 50-60% of patients respond to DBS. As a result of stimulation, most patients' lives gradually returns to normal and most resumes work. Further refinement of targeting and patient selection is expected to improve the success rate of pHyp stimulation in CCH patients. The cost of the procedure is largely compensated by one year of pain remission even if the disease cannot be cured by DBS.
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UR - http://www.scopus.com/inward/citedby.url?scp=84882895029&partnerID=8YFLogxK
U2 - 10.1016/B978-0-12-374248-3.00040-9
DO - 10.1016/B978-0-12-374248-3.00040-9
M3 - Chapter
AN - SCOPUS:84882895029
SN - 9780123742483
VL - 1
SP - 509
EP - 513
BT - Neuromodulation
PB - Elsevier Ltd
ER -