Lessons from 8 years' experience of hypothalamic stimulation in cluster headache.

M. Leone, A. Proietti Cecchini, A. Franzini, G. Broggi, P. Cortelli, P. Montagna, A. May, T. Juergens, R. Cordella, F. Carella, G. Bussone

Research output: Contribution to journalArticle

112 Citations (Scopus)

Abstract

Neuroimaging studies in cluster headache (CH) patients have increased understanding of attack-associated events and provided clues to the pathophysiology of the condition. They have also suggested stimulation of the ipsilateral posterior inferior hypothalamus as a treatment for chronic intractable CH. After 8 years of experience, stimulation has proved successful in controlling the pain attacks in almost 60% of chronic CH patients implanted at various centres. Although hypothalamic implant is not without risks, it has generally been performed safely. Implantation affords an opportunity to perform microrecordings of individual posterior hypothalamic neurons. These studies are at an early stage, but suggest the possibility of identifying precisely the target site by its electrophysiological characteristics. Autonomic studies of patients undergoing posterior hypothalamic stimulation provide further evidence that long-term stimulation is safe, revealing that it can cause altered modulation of the mechanisms of orthostatic adaptation without affecting the baroreflex, cardiorespiratory interactions or efferent sympathetic and vagal functions. Chronically stimulated patients have an increased threshold for cold pain at the site of the first trigeminal branch ipsilateral to the stimulated side; when the stimulator is switched off, changes in sensory and pain thresholds do not occur immediately, suggesting that long-term stimulation is required to induce sensory and nociceptive changes. Posterior inferior hypothalamic stimulation is now established as a treatment for many chronic CH patients. The technique is shedding further light on the pathophysiology of the disease, and is also providing clues to functioning of the hypothalamus itself.

Original languageEnglish
JournalCephalalgia
Volume28
Issue number7
DOIs
Publication statusPublished - Jul 2008

Fingerprint

Cluster Headache
Pain Threshold
Sensory Thresholds
Posterior Hypothalamus
Headache Disorders
Baroreflex
Neuroimaging
Hypothalamus
Neurons
Pain
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Lessons from 8 years' experience of hypothalamic stimulation in cluster headache. / Leone, M.; Proietti Cecchini, A.; Franzini, A.; Broggi, G.; Cortelli, P.; Montagna, P.; May, A.; Juergens, T.; Cordella, R.; Carella, F.; Bussone, G.

In: Cephalalgia, Vol. 28, No. 7, 07.2008.

Research output: Contribution to journalArticle

Leone, M, Proietti Cecchini, A, Franzini, A, Broggi, G, Cortelli, P, Montagna, P, May, A, Juergens, T, Cordella, R, Carella, F & Bussone, G 2008, 'Lessons from 8 years' experience of hypothalamic stimulation in cluster headache.', Cephalalgia, vol. 28, no. 7. https://doi.org/10.1111/j.1468-2982.2008.01627.x
Leone, M. ; Proietti Cecchini, A. ; Franzini, A. ; Broggi, G. ; Cortelli, P. ; Montagna, P. ; May, A. ; Juergens, T. ; Cordella, R. ; Carella, F. ; Bussone, G. / Lessons from 8 years' experience of hypothalamic stimulation in cluster headache. In: Cephalalgia. 2008 ; Vol. 28, No. 7.
@article{645bf5b75c4e4df8a046a4864f180974,
title = "Lessons from 8 years' experience of hypothalamic stimulation in cluster headache.",
abstract = "Neuroimaging studies in cluster headache (CH) patients have increased understanding of attack-associated events and provided clues to the pathophysiology of the condition. They have also suggested stimulation of the ipsilateral posterior inferior hypothalamus as a treatment for chronic intractable CH. After 8 years of experience, stimulation has proved successful in controlling the pain attacks in almost 60{\%} of chronic CH patients implanted at various centres. Although hypothalamic implant is not without risks, it has generally been performed safely. Implantation affords an opportunity to perform microrecordings of individual posterior hypothalamic neurons. These studies are at an early stage, but suggest the possibility of identifying precisely the target site by its electrophysiological characteristics. Autonomic studies of patients undergoing posterior hypothalamic stimulation provide further evidence that long-term stimulation is safe, revealing that it can cause altered modulation of the mechanisms of orthostatic adaptation without affecting the baroreflex, cardiorespiratory interactions or efferent sympathetic and vagal functions. Chronically stimulated patients have an increased threshold for cold pain at the site of the first trigeminal branch ipsilateral to the stimulated side; when the stimulator is switched off, changes in sensory and pain thresholds do not occur immediately, suggesting that long-term stimulation is required to induce sensory and nociceptive changes. Posterior inferior hypothalamic stimulation is now established as a treatment for many chronic CH patients. The technique is shedding further light on the pathophysiology of the disease, and is also providing clues to functioning of the hypothalamus itself.",
author = "M. Leone and {Proietti Cecchini}, A. and A. Franzini and G. Broggi and P. Cortelli and P. Montagna and A. May and T. Juergens and R. Cordella and F. Carella and G. Bussone",
year = "2008",
month = "7",
doi = "10.1111/j.1468-2982.2008.01627.x",
language = "English",
volume = "28",
journal = "Cephalalgia",
issn = "0333-1024",
publisher = "SAGE Publications Ltd",
number = "7",

}

TY - JOUR

T1 - Lessons from 8 years' experience of hypothalamic stimulation in cluster headache.

AU - Leone, M.

AU - Proietti Cecchini, A.

AU - Franzini, A.

AU - Broggi, G.

AU - Cortelli, P.

AU - Montagna, P.

AU - May, A.

AU - Juergens, T.

AU - Cordella, R.

AU - Carella, F.

AU - Bussone, G.

PY - 2008/7

Y1 - 2008/7

N2 - Neuroimaging studies in cluster headache (CH) patients have increased understanding of attack-associated events and provided clues to the pathophysiology of the condition. They have also suggested stimulation of the ipsilateral posterior inferior hypothalamus as a treatment for chronic intractable CH. After 8 years of experience, stimulation has proved successful in controlling the pain attacks in almost 60% of chronic CH patients implanted at various centres. Although hypothalamic implant is not without risks, it has generally been performed safely. Implantation affords an opportunity to perform microrecordings of individual posterior hypothalamic neurons. These studies are at an early stage, but suggest the possibility of identifying precisely the target site by its electrophysiological characteristics. Autonomic studies of patients undergoing posterior hypothalamic stimulation provide further evidence that long-term stimulation is safe, revealing that it can cause altered modulation of the mechanisms of orthostatic adaptation without affecting the baroreflex, cardiorespiratory interactions or efferent sympathetic and vagal functions. Chronically stimulated patients have an increased threshold for cold pain at the site of the first trigeminal branch ipsilateral to the stimulated side; when the stimulator is switched off, changes in sensory and pain thresholds do not occur immediately, suggesting that long-term stimulation is required to induce sensory and nociceptive changes. Posterior inferior hypothalamic stimulation is now established as a treatment for many chronic CH patients. The technique is shedding further light on the pathophysiology of the disease, and is also providing clues to functioning of the hypothalamus itself.

AB - Neuroimaging studies in cluster headache (CH) patients have increased understanding of attack-associated events and provided clues to the pathophysiology of the condition. They have also suggested stimulation of the ipsilateral posterior inferior hypothalamus as a treatment for chronic intractable CH. After 8 years of experience, stimulation has proved successful in controlling the pain attacks in almost 60% of chronic CH patients implanted at various centres. Although hypothalamic implant is not without risks, it has generally been performed safely. Implantation affords an opportunity to perform microrecordings of individual posterior hypothalamic neurons. These studies are at an early stage, but suggest the possibility of identifying precisely the target site by its electrophysiological characteristics. Autonomic studies of patients undergoing posterior hypothalamic stimulation provide further evidence that long-term stimulation is safe, revealing that it can cause altered modulation of the mechanisms of orthostatic adaptation without affecting the baroreflex, cardiorespiratory interactions or efferent sympathetic and vagal functions. Chronically stimulated patients have an increased threshold for cold pain at the site of the first trigeminal branch ipsilateral to the stimulated side; when the stimulator is switched off, changes in sensory and pain thresholds do not occur immediately, suggesting that long-term stimulation is required to induce sensory and nociceptive changes. Posterior inferior hypothalamic stimulation is now established as a treatment for many chronic CH patients. The technique is shedding further light on the pathophysiology of the disease, and is also providing clues to functioning of the hypothalamus itself.

UR - http://www.scopus.com/inward/record.url?scp=48849100541&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=48849100541&partnerID=8YFLogxK

U2 - 10.1111/j.1468-2982.2008.01627.x

DO - 10.1111/j.1468-2982.2008.01627.x

M3 - Article

C2 - 18547215

AN - SCOPUS:44849126390

VL - 28

JO - Cephalalgia

JF - Cephalalgia

SN - 0333-1024

IS - 7

ER -