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Neurostimulation in chronic cluster headache

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Abstract

About 1% of all chronic cluster headache patients become intractable (iCCH; ie, they are refractory to adequate regimens of all established preventive drugs). Various lesional interventions have been attempted in these patients, none with lasting benefits. In recent years, nondestructive neurostimulation methods have raised new hope. Hypothalamic deep brain stimulation (hDBS) acts rather rapidly and has durable efficacy, but it is not without risk. Occipital nerve stimulation (ONS) was studied in two trials that included 17 iCCH patients. Clinical efficacy was found to be very satisfactory by most patients and investigators. Although slightly less efficacious than hDBS, ONS has the advantage of being harmless and reversible. At this stage, it should be the preferred first-line invasive therapy for iCCH. Recent case reports mention efficacy of supraorbital and vagus nerve stimulation. Whether these neurostimulation methods have a place in the management of iCCH patients remains to be determined.

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References and Recommended Reading

  1. Headache Classification Subcommittee of the International Headache Society: The International Classification of Headache Disorders 2nd Edition. Cephalalgia 2004, 24(Suppl 1):9–160.

    Google Scholar 

  2. Sjaastad O, Bakketeig LS: Cluster headache prevalence. Vaga study of headache epidemiology. Cephalalgia 2003, 23:528–533.

    Article  CAS  PubMed  Google Scholar 

  3. Goadsby PJ, Schoenen J, Ferrari MD, et al.: Towards a definition of intractable headache for use in clinical practice and trials. Cephalalgia 2006, 26:1168–1170.

    Article  CAS  PubMed  Google Scholar 

  4. Matharu MS, Boes CJ, Goadsby PJ: Management of trigeminal autonomic cephalgias and hemicrania continua. Drugs 2003, 63:1637–1677.

    Article  CAS  PubMed  Google Scholar 

  5. Sprenger T, Boecker H, Tolle TR, et al.: Specific hypothalamic activation during a spontaneous cluster headache attack. Neurology 2004, 62:516–517.

    CAS  PubMed  Google Scholar 

  6. May A, Bahra A, Buchel C, et al.: Hypothalamic activation in cluster headache attacks. Lancet 1998, 352:275–278.

    Article  CAS  PubMed  Google Scholar 

  7. May A, Ashburner J, Buchel C, et al.: Correlation between structural and functional changes in brain in an idiopathic headache syndrome. Nat Med 1999, 5:836–838.

    Article  CAS  PubMed  Google Scholar 

  8. Kupers RC, Svensson P, Jensen TS: Central representation of muscle pain and mechanical hyperesthesia in the orofacial region: a positron emission tomography study. Pain 2004, 108:284–293.

    Article  PubMed  Google Scholar 

  9. Petrovic P, Petersson KM, Hansson P, Ingvar M: Brainstem involvement in the initial response to pain. Neuroimage 2004, 22:995–1005.

    Article  PubMed  Google Scholar 

  10. May A: Cluster headache: pathogenesis, diagnosis, and management. Lancet 2005, 366:843–855.

    Article  PubMed  Google Scholar 

  11. Leone M, Franzini A, Bussone G: Stereotactic stimulation of posterior hypothalamic gray matter in a patient with intractable cluster headache. N Engl J Med 2001, 345:1428–1429.

    Article  CAS  PubMed  Google Scholar 

  12. Franzini A, Ferroli P, Leone M, Broggi G: Stimulation of the posterior hypothalamus for treatment of chronic intractable cluster headaches: first reported series. Neurosurgery 2003, 52:1095–1099.

    Article  PubMed  Google Scholar 

  13. Leone M, Franzini A, Broggi G, et al.: Long-term follow-up of bilateral hypothalamic stimulation for intractable cluster headache. Brain 2004, 127:2259–2264.

    Article  CAS  PubMed  Google Scholar 

  14. Leone M, Franzini A, Broggi G, Bussone G: Hypothalamic stimulation for intractable cluster headache: long-term experience. Neurology 2006, 67:150–152.

    Article  PubMed  Google Scholar 

  15. Broggi G, Franzini A, Leone M, Bussone G: Update on neurosurgical treatment of chronic trigeminal autonomic cephalalgias and atypical facial pain with deep brain stimulation of posterior hypothalamus: results and comments. Neurol Sci 2007, 28(Suppl 2):S138–S145.

    Article  PubMed  Google Scholar 

  16. Schoenen J, Di Clemente L, Vandenheede M, et al.: Hypothalamic stimulation in chronic cluster headache: a pilot study of efficacy and mode of action. Brain 2005, 128:940–947.

    Article  CAS  PubMed  Google Scholar 

  17. Starr PA, Barbaro NM, Raskin NH, Ostrem JL: Chronic stimulation of the posterior hypothalamic region for cluster headache: technique and 1-year results in four patients. J Neurosurg 2007, 106:999–1005.

    Article  PubMed  Google Scholar 

  18. Rasche D, Foethke D, Gliemroth J, Tronnier VM: Deep brain stimulation in the posterior hypothalamus for chronic cluster headache. Case report and review of the literature. Schmerz 2006 [Epub ahead of print].

  19. Lyons KE, Wilkinson SB, Overman J, Pahwa R: Surgical and hardware complications of subthalamic stimulation: a series of 160 procedures. Neurology 2004, 63:612–616.

    PubMed  Google Scholar 

  20. Nilsson Remahl AI, Laudon ME, Cordonnier C, Goadsby PJ: Placebo response in cluster headache trials: a review. Cephalalgia 2003, 23:504–510.

    Article  CAS  PubMed  Google Scholar 

  21. May A, Leone M, Boecker H, et al.: Hypothalamic deep brain stimulation in positron emission tomography. J Neurosci 2006, 26:3589–3593.

    Article  CAS  PubMed  Google Scholar 

  22. Bartsch T, Goadsby PJ: Increased responses in trigeminocervical nociceptive neurons to cervical input after stimulation of the dura mater. Brain 2003, 126:1801–1813.

    Article  CAS  PubMed  Google Scholar 

  23. Anthony M: Arrest of attacks of cluster headache by local steroid injection of the occipital nerve. In Migraine: Clinical and Research Advances. Edited by Rose FC. London: Karger; 1985:169–173.

    Google Scholar 

  24. Ambrosini A, Vandenheede M, Rossi P, et al.: Suboccipital injection with a mixture of rapid-and long-acting steroids in cluster headache: a double-blind placebo-controlled study. Pain 2005, 118:92–96.

    Article  CAS  PubMed  Google Scholar 

  25. Oh MY, Ortega J, Bellotte JB, et al.: Peripheral nerve stimulation for the treatment of occipital neuralgia and transformed migraine using a C1-2-3 subcutaneous paddle style electrode: a technical report. Neuromodulation 2004, 7:103–112.

    Article  Google Scholar 

  26. Matharu MS, Bartsch T, Ward N, et al.: Central neuromodulation in chronic migraine patients with suboccipital stimulators: a PET study. Brain 2004, 127:220–230.

    Article  PubMed  Google Scholar 

  27. Schwedt T, Dodick D, Hentz J, et al.: Occipital nerve stimulation for chronic headache—long-term safety and efficacy. Cephalalgia 2007, 27:153–157.

    Article  CAS  PubMed  Google Scholar 

  28. Burns B, Watkins L, Goadsby PJ: Treatment of medically intractable cluster headache by occipital nerve stimulation: long-term follow-up of eight patients. Lancet 2007, 369:1099–1106.

    Article  PubMed  Google Scholar 

  29. Magis D, Allena M, Bolla M, et al.: Occipital nerve stimulation for drug-resistant chronic cluster headache: a prospective pilot study. Lancet Neurol 2007, 6:314–321.

    Article  PubMed  Google Scholar 

  30. Schwedt TJ, Dodick DW, Trentman TL, Zimmerman RS: Occipital nerve stimulation for chronic cluster headache and hemicrania continua: pain relief and persistence of autonomic features. Cephalalgia 2006, 26:1025–1027.

    Article  CAS  PubMed  Google Scholar 

  31. Narouze SN, Kapural L: Supraorbital nerve electric stimulation for the treatment of intractable chronic cluster headache: a case report. Headache 2007, 47:1100–1102.

    Article  PubMed  Google Scholar 

  32. Mauskop A: Vagus nerve stimulation relieves chronic refractory migraine and cluster headaches. Cephalalgia 2005, 25:82–86.

    Article  CAS  PubMed  Google Scholar 

  33. Bartsch T, Pinsker MO, Rasche D, et al.: Hypothalamic deep brain stimulation for cluster headache: experience from a new multicase series. Cephalalgia 2008, 28:285–295.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Headache Research Unit, Department of Neurology and Research Centre for Neurobiology, CHR Citadelle, Bd du 12ème de Ligne 1, 4000, Liège, Belgium

    Jean Schoenen

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  1. Delphine Magis
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  2. Jean Schoenen
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Correspondence to Jean Schoenen.

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Magis, D., Schoenen, J. Neurostimulation in chronic cluster headache. Current Science Inc 12, 145–153 (2008). https://doi.org/10.1007/s11916-008-0027-0

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  • DOI: https://doi.org/10.1007/s11916-008-0027-0

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