Neurological Sciences

, Volume 29, Supplement 1, pp 62–64 | Cite as

Long-term experience of neuromodulation in TACs

  • Alberto Proietti Cecchini
  • Eliana Mea
  • Vincenzo Tullo
  • Cesare Peccarisi
  • Gennaro Bussone
  • Massimo LeoneEmail author
Drug-Resistant Primary Headaches


Improvement in the biomedical and biotechnological research fields have allowed refinement of the neuromodulation approach in the treatment of a subgroup of medical disorders otherwise refractory to pharmacological treatment, such as chronic primary headaches. Chronic pain conditions imply central sensitisations and functional reorganisation that cannot be quickly or easily reversed. It appears evident that conventional treatment can sometimes be unsuccessful or only partially successful, and that relapse is common. Cluster headache (CH) is the most frequent trigeminal autonomic cephalalgia (TAC) and the most representative of this spectrum of disorders characterised by the association of headache and loco-regional signs and symptoms of facial parasympathetic activation. The striking features of circadian rhythmicity of attacks and circannual periodicity of cluster period, together with the neuroendocrine abnormalities, are suggestive of a neurochronobiological disorder with a central-diencephalic pathogenetic involvement, confirmed by direct evidence in functional neuroimaging studies of ipsilateral posterior hypothalamic activation during cluster attack. In 2000 these findings prompted a functional neurosurgery approach, with the first case of deep brain hypothalamic stimulation (DBS) in a severely disabled chronic CH patient. Since then, 18 implants in our centre and many others in different countries have been performed. Although the outcomes are encouraging, the invasive nature of the technique and the occurrence of rare but major adverse events have suggested a safer peripheral approach with occipital nerve stimulation (ONS).


Cluster headache SUNCT TACs Neurostimulation DBS Occipital nerve ONS 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Headache Classification Committee of the International Headache Society (2004) The International Classification of Headache Disorders, 2nd Edn. Cephalalgia 24[Suppl 1]:1–160Google Scholar
  2. 2.
    Goadsby PJ, Lipton RB (1997) A review of paroxysmal hemicranias, SUNCT syndrome and other short-lasting headaches with autonomic feature, including new cases. Brain 120:193–209PubMedCrossRefGoogle Scholar
  3. 3.
    Goadsby PJ, Edvinsson L (1994) Human in vivo evidence for trigeminovascular activation in cluster headache. Brain 117:427–434PubMedCrossRefGoogle Scholar
  4. 4.
    Goadsby PJ, Edvinsson L, Ekman R (1988) Release of vasoactive peptides in the extracerebral circulation of man and the cat during activation of the trigeminovascular system. Ann Neurol 23:193–196PubMedCrossRefGoogle Scholar
  5. 5.
    Sprenger T, Boecker H, Toelle TR et al (2004) Specific hypothalamic activation during a spontaneous cluster headache attack. Neurology 3:516–517Google Scholar
  6. 6.
    May A, Bahra A, Buchel C et al (1998) Hypothalamic activation in cluster headache attacks. Lancet 352:275–278PubMedCrossRefGoogle Scholar
  7. 7.
    May A, Bahra A, Buchel C et al (1999) Functional MRI in spontaneous attacks of SUNCT: short-lasting neuralgiform headache with conjunctival injection and tearing. Ann Neurol 46:791–793PubMedCrossRefGoogle Scholar
  8. 8.
    Matharu MS, Cohen AS, Frackowiak RSJ, Goadsby PJ (2006) Posterior hypothalamic activation in paroxysmal hemicrania. Ann Neurol 59:535–545PubMedCrossRefGoogle Scholar
  9. 9.
    May A, Ashburner J, Buchel C et al (1999) Correlation between structural and functional changes in brain in an idiopathic headache syndrome. Nat Med 5:836–838PubMedCrossRefGoogle Scholar
  10. 10.
    Lodi R, Pierangeli G, Tonon C et al (2006) Study of hypothalamic metabolism in cluster headache by proton MR spectroscopy. Neurology 66:1264–1266PubMedCrossRefGoogle Scholar
  11. 11.
    Wang SJ, Lirng JF, Fuh JL, Chen JJ (2006) Reduction in hypothalamic 1H-MRS metabolite ratios in patients with cluster headache. J Neurol Neurosurg Psychiatry 77:622–662PubMedCrossRefGoogle Scholar
  12. 12.
    Leone M, Franzini A, Bussone G (2001) Stereotactic stimulation of posterior hypothalamic gray matter for intractable cluster headache. N Engl J Med 345:1428–1429PubMedCrossRefGoogle Scholar
  13. 13.
    Leone M, Franzini A, Broggi G et al (2004) Long-term follow up of bilateral hypothalamic stimulation for intractable cluster headache. Brain 127:2259–2264PubMedCrossRefGoogle Scholar
  14. 14.
    Leone M, Franzini A, Broggi G, Bussone G (2006) Hypothalamic stimulation for intractable cluster headache: long-term experience. Neurology 67:150–152PubMedCrossRefGoogle Scholar
  15. 15.
    Schoenen J, Di Clemente L, Vandenheede M et al (2005) Hypothalamic stimulation in chronic cluster headache: a pilot study of efficacy and mode of action. Brain 128:940–947PubMedCrossRefGoogle Scholar
  16. 16.
    Starr PA, Barbaro NM, Raskin NH, Ostrem JL (2007) Chronic stimulation of the posterior hypothalamic region for cluster headache: technique and 1-year results in four patients. J Neurosurg 106:999–1005PubMedCrossRefGoogle Scholar
  17. 17.
    Bartsch T, Pinsker MO, Rasche D et al (2008) Hypothalamic deep brain stimulation for cluster headache-experience from a new multicase series. Cephalalgia 28:285–295PubMedCrossRefGoogle Scholar
  18. 18.
    D’Andrea G, Nordera GP, Piacentino M (2006) Effectiveness of hypothalamic stimulation in two patients affected by intractable chronic cluster headache. Neurol [Suppl 2]:A 140Google Scholar
  19. 19.
    Cortelli P, Guaraldi P, Leone M et al (2007) Effect of deep brain stimulation of the posterior hypothalamic area on the cardiovascular system in chronic cluster headache patients. Eur J Neurol 14:1008–1015PubMedCrossRefGoogle Scholar
  20. 20.
    Vetrugno R, Pierangeli G, Leone M et al (2007) Effect on sleep of posterior hypothalamus stimulation in cluster headache. Headache 47:1085–1090PubMedCrossRefGoogle Scholar
  21. 21.
    Leone M, Franzini A, D’Andrea G et al (2005) Deep brain stimulation to relieve severe drug-resistant SUNCT. Ann Neurol 57:924–927PubMedCrossRefGoogle Scholar
  22. 22.
    Popeney CA, Alò KM (2003) Peripheral neurostimulation for the treatment of chronic, disabling transformed migraine. Headache 43:369–375PubMedCrossRefGoogle Scholar
  23. 23.
    Goadsby PJ, Bartsch T, Dodick DW (2008) Occipital nerve stimulation for headache: mechanisms and efficacy. Headache 48:313–318PubMedCrossRefGoogle Scholar
  24. 24.
    Magis D, Allena M, Bolla M et al (2007) Occipital nerve stimulation for drug-resistant chronic cluster headache: a prospective pilot study. Lancet Neurol 6:314–321PubMedCrossRefGoogle Scholar
  25. 25.
    Leone M, Franzini A, Proietti Cecchini A et al (2007) Stimulation of occipital nerve for drug-resistant chronic cluster headache. Lancet Neurol 6:289–291PubMedCrossRefGoogle Scholar
  26. 26.
    Burns B, Watkins L, Goadsby PJ (2007) Treatment of medically intractable cluster headache by occipital nerve stimulation: long-term follow-up of eight patients. Lancet 369:1099–1106PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • Alberto Proietti Cecchini
    • 1
  • Eliana Mea
    • 1
  • Vincenzo Tullo
    • 1
  • Cesare Peccarisi
    • 1
  • Gennaro Bussone
    • 1
  • Massimo Leone
    • 1
    Email author
  1. 1.National Neurological Institute (IRCCS) Foundation “C. Besta”Headache CentreMilanItaly

Personalised recommendations