Neurological Sciences

, Volume 30, Supplement 1, pp 43–47 | Cite as

Costs of hypothalamic stimulation in chronic drug-resistant cluster headache: preliminary data

  • M. LeoneEmail author
  • A. Franzini
  • A. Proietti Cecchini
  • E. Mea
  • G. Broggi
  • G. Bussone


In about 20% of chronic cluster headache (CH) cases, drugs may become ineffective. Under these circumstances, steroids and triptans are frequently employed leading to fearful side effects in one and high costs in the other. The direct costs of drug-resistant chronic CH are mainly due to frequent medical consultations and frequent use of expensive drugs. In recent years, hypothalamic stimulation has been employed to treat drug-resistant chronic CH patients suffering multiple daily attacks and long-term results from different centres show a 60% overall benefit. Nine years since the introduction of this technique, we attempt a preliminary analysis of the direct costs of hypothalamic stimulation based on patients treated at our centre. We estimated the following direct costs as follows: cost of neurosurgery plus cost of equipment (electrode, connection and impulse generator = 25,000 euro), cost of hospital admissions in long-term follow-up (2,000 euro per admission), cost of single sumatriptan injection (25 euro). Number of daily sumatriptan injections in the year before and for each year after hypothalamic implantation was obtained from headache diaries. To estimate the saving due to the reduction in sumatriptan consumption following hypothalamic stimulation, we calculated the following for each year of follow-up after surgery: number of sumatriptan injections in the year before surgery minus number of sumatriptan injections in each year, updated to December 2008. In our 19 implanted patients, the costs of neurosurgery plus cost of equipment were 475,000 euro; the costs of hospital admissions during follow up were 250,000 euro. Reduction in sumatriptan consumption resulted in a total saving of 3,573,125 euro. Hence, in our 19 patients, the sumatriptan saving (3,573,125 euros) minus the direct costs due to operation and follow up hospitalisations (475,000 + 250,000) euro is equal to 2,848,125 euros. These preliminary results indicate that hypothalamic stimulation is associated with marked reduction of direct costs in the management of complete drug-resistant chronic CH.


Hypothalamic stimulation Cluster headache Intractable Costs 


Conflict of interest statement

The authors declare that they have no conflict of interest related to the publication of this manuscript.


  1. 1.
    Headache Classification Committee of The International Headache Society (2004) The International Classification of Headache Disorders (second edition). Cephalalgia 24:1–195Google Scholar
  2. 2.
    Manzoni GC, Micieli G, Granella F, Tassorelli C, Zanferrari C, Cavallini A (1991) Cluster headache-course over ten years in 189 patients. Cephalalgia 11:169–174PubMedCrossRefGoogle Scholar
  3. 3.
    Leone M, Franzini A, Proietti Cecchini A, Mea E, Broggi G, Bussone G (2009) Cluster headache: pharmacological treatment and neurostimulation. Nat Clin Pract Neurol 5:153–162PubMedCrossRefGoogle Scholar
  4. 4.
    The Sumatriptan Cluster Headache Study Group (1991) Treatment of acute cluster headache with sumatriptan. N Engl J Med 325:322–326Google Scholar
  5. 5.
    Leone M, Franzini A, Broggi G, Bussone G (2006) Hypothalamic stimulation for intractable cluster headache: long-term experience. Neurology 67:150–152PubMedCrossRefGoogle Scholar
  6. 6.
    Ekbom K et al (1995) Cluster headache attacks treated for up to three months with subcutaneous sumatriptan (6 mg). Sumatriptan Cluster Headache Long-term Study Group. Cephalalgia 15:230–236PubMedCrossRefGoogle Scholar
  7. 7.
    Göbel H (1998) Acute therapy for cluster headache with sumatriptan: findings of a one-year long-term study. Neurology 51:908–911PubMedGoogle Scholar
  8. 8.
    Dodick DW et al (2004) Cardiovascular tolerability and safety of triptans: a review of clinical data. Headache 44(Suppl 1):S20–S30PubMedCrossRefGoogle Scholar
  9. 9.
    D’Amico D, Rigamonti A, Solari A, Leone M, Usai S, Grazzi L, Bussone G (2002) Health-related quality of life in patients with cluster headache during active periods. Cephalalgia 22(10):818–821PubMedCrossRefGoogle Scholar
  10. 10.
    Leone M, Franzini A, Bussone G (2001) Stereotactic stimulation of posterior hypothalamic gray matter for intractable cluster headache. NEJM 345(19):1428–1429PubMedCrossRefGoogle Scholar
  11. 11.
    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
  12. 12.
    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
  13. 13.
    Bartsch T, Pinsker MO, Rasche D et al (2008) Hypothalamic deep brain stimulation for cluster headache–experience from a new multicase series. Cephalalgia 28(3):285–295PubMedCrossRefGoogle Scholar
  14. 14.
    Owen SLF, Green AL, Davies P et al (2007) Connectivity of an effective hypothalamic surgical target for cluster headache. J Clin Neurosci 14(10):955–960PubMedCrossRefGoogle Scholar
  15. 15.
    Magis D, Allena M, Bolla M, De Pasqua V, Remacle JM, Schoenen J (2007) Occipital nerve stimulation for drug-resistant chronic cluster headache: a prospective pilot study. Lancet Neurol 6:314–321PubMedCrossRefGoogle Scholar
  16. 16.
    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(9567):1099–1106PubMedCrossRefGoogle Scholar
  17. 17.
    Schwedt TJ, Dodick DW, Hentz J, Trentman TL, Zimmerman RS (2007) Occipital nerve stimulation for chronic headache—long-term safety and efficacy. Cephalalgia 27:153–157PubMedCrossRefGoogle Scholar
  18. 18.
    May A, Bahra A, Buchel C, Frackowiak RS, Goadsby PJ (1998) Hypothalamic activation in cluster headache attacks. Lancet 352:275–278PubMedCrossRefGoogle Scholar
  19. 19.
    May A, Ashburner J, Buchel C, McGonigle DJ, Friston KJ, Frackowiak RS, Goadsby PJ (1999) Correlation between structural and functional changes in brain in idiopathic headache syndrome. Nat Med 7:836–838Google Scholar
  20. 20.
    Goadsby PJ (2002) Pathophysiology of cluster headache: a trigeminal autonomic cephalgia. Lancet Neurol 1:251–257PubMedCrossRefGoogle Scholar
  21. 21.
    May A (2005) Cluster headache: pathogenesis, diagnosis, and management. Lancet 366:843–855PubMedCrossRefGoogle Scholar
  22. 22.
    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 28:789–797Google Scholar
  23. 23.
    Leone M, May A, Franzini A et al (2004) Deep brain stimulation for intractable chronic cluster headache: proposals for patient selection. Cephalalgia 24(11):934–937PubMedCrossRefGoogle Scholar
  24. 24.
    Leone M, Proietti A, Mea E, D’Amico D, Tullo V, Grazzi L, Bussone G (2008) Therapeutic neurostimulation in chronic headaches: problems of patient selection. Neurol Sci 29:S59–S61PubMedCrossRefGoogle Scholar
  25. 25.
    Leone M, Franzini A, Proietti Cecchini A, Broggi G, Bussone G (2007) Stimulation of occipital nerve for drug-resistant chronic cluster headache. Lancet Neurol 6(4):289–291PubMedCrossRefGoogle Scholar
  26. 26.
    Lipton RB, Micieli G, Russell D, Solomon S, Tfelt-Hansen P, Waldenlind E (1995) Guidelines for controlled trials of drugs in cluster headache. Cephalalgia 15:455–462CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • M. Leone
    • 1
    Email author
  • A. Franzini
    • 2
  • A. Proietti Cecchini
    • 1
  • E. Mea
    • 1
  • G. Broggi
    • 2
  • G. Bussone
    • 1
  1. 1.Headache Centre, National Neurological Institute C. BestaMilanItaly
  2. 2.Department of NeurosurgeryFondazione Istituto Nazionale Neurologico Carlo BestaMilanItaly

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