Neurological Sciences

, 29:65

Neuromodulation in treatment of refractory headaches

  • Angelo Franzini
  • Massimo Leone
  • Giuseppe Messina
  • Roberto Cordella
  • Carlo Marras
  • Gennaro Bussone
  • Giovanni Broggi
Drug-Resistant Primary Headaches

Abstract

The field of neuromodulation is emerging as a promising and alternative therapeutical option for many drug-resistant clinical conditions, including painful syndromes such as refractory chronic cluster headache (CCH) and trigeminal neuralgia. We here report a series of patients who have undergone Deep Brain Stimulation (DBS) of Posterior Hypothalamus for chronic cluster headache, trigeminal neuralgia and atypical facial pain, matching their corresponding clinical results and also suggesting a role for Great Occipital Nerve Stimulation (which is a much less invasive procedure) in the treatment of CCH. According to us, the refinement of surgical techniques and of metabolic and functional brain neuroradiological investigations will lead to a refinement of the therapeutical strategies in such patients.

Keywords

Trigeminal neuralgia Cluster headache Neuromodulation 

References

  1. 1.
    Leone M, Franzini A, Bussone G (2001) Stereotactic stimulation of posterior hypothalamic gray matter in a patient with intractable cluster headache. N Engl J Med 345:1428–1429PubMedCrossRefGoogle Scholar
  2. 2.
    May A, Bahra A, Buchel C et al (1998) Hypothalamic activation in cluster headache attacks. Lancet 352:275–278PubMedCrossRefGoogle Scholar
  3. 3.
    Sano K, Mayanagi Y, Sekino H et al (1970) Results of stimulation and destruction of the posterior hypothalamus in man. J Neurosurg 33:689–707PubMedCrossRefGoogle Scholar
  4. 4.
    Franzini A, Ferroli P, Leone M et al (2004) Hypothalamic deep brain stimulation for the treatment of chronic cluster headaches: a series report. Neuromodulation 7:1–8CrossRefGoogle Scholar
  5. 5.
    Franzini A, Ferroli P, Leone M, Broggi G (2003) Stimulation of the posterior hypothalamus for treatment of chronic intractable cluster headaches: first reported series. Neurosurgery 52:1095–1099PubMedCrossRefGoogle Scholar
  6. 6.
    Franzini A, Marras C, Tringali G et al (2007) Chronic high frequency stimulation of the posteromedial hypothalamus in facial pain syndromes and behaviour disorders. Acta Neurochir Suppl 97:399–406PubMedGoogle Scholar
  7. 7.
    Leone M, Franzini A, D’Andrea G et al (2005) Deep brain stimulation to relieve drug-resistant SUNCT. Ann Neurol 57:924–927PubMedCrossRefGoogle Scholar
  8. 8.
    Leone M, Franzini A, Broggi G, Bussone G (2006) Hypothalamic stimulation for intractable cluster headache: longterm experience. Neurology 67:150–152PubMedCrossRefGoogle Scholar
  9. 9.
    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
  10. 10.
    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
  11. 11.
    Burns B, Watkins L, Goadsby PJ (2007) Treatment of medically intractable cluster headache by occipital nerve stimulation: longterm follow-up of eight patients. Lancet 369:1099–1106PubMedCrossRefGoogle Scholar
  12. 12.
    Cordella R, Carella F, Leone M et al (2007) Spontaneous neuronal activity of the posterior hypothalamus in trigeminal autonomic cephalalgias. Neurol Sci 28:93–95PubMedCrossRefGoogle Scholar
  13. 13.
    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
  14. 14.
    Ferroli P, Franzini A, Marras C et al (2004) A simple method to assess accuracy of deep brain stimulation electrode placement: pre-operative stereotactic CT-postoperative MR image fusion. Stereotact Funct Neurosurg 82:14–19PubMedCrossRefGoogle Scholar
  15. 15.
    Headache Classification Committee of The International Headache Society (2004) The International Classification of Headache Disorders (2nd Edn). Cephalalgia 24:1–195Google Scholar
  16. 16.
    Jarrar RG, Black DF, Dodick DW, Davis DH (2003) Outcome of trigeminal nerve section in the treatment of chronic cluster headache. Neurology 60:1360–1362PubMedCrossRefGoogle Scholar
  17. 17.
    Leone M, Franzini A, Cecchini AP et al (2007) Stimulation of occipital nerve for drug-resistant chronic cluster headache. Lancet Neurol 6:289–291PubMedCrossRefGoogle Scholar
  18. 18.
    Torelli P, Manzoni GC (2003) Pain and behaviour in cluster headache. A prospective study and review of the literature. Funct Neurol 18:205–210PubMedGoogle Scholar
  19. 19.
    Malick A, Strassman AM, Burstein R (2000) Trigemino hypothalamic and reticulohypothalamic tract neurons in the upper cervical spinal cord and caudal medulla of the rat. J Neurophysiol 84:2078–2112PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • Angelo Franzini
    • 1
  • Massimo Leone
    • 1
  • Giuseppe Messina
    • 1
  • Roberto Cordella
    • 1
  • Carlo Marras
    • 1
  • Gennaro Bussone
    • 1
  • Giovanni Broggi
    • 1
  1. 1.Neurological Institute Foundation “C. Besta”MilanItaly

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