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Deep Brain Stimulation for Medically Intractable Cluster Headache

  • Philip A. Starr
  • Andrew Ahn
Part of the Current Clinical Neurology book series (CCNEU)

Abstract

Cluster headache (CH) is the most severe of the primary headache disorders. It affects approximately 1 in 1000 persons, and 20% of patients are significantly disabled in spite of optimal medical therapy (1). Peripheral nerve ablation procedures have been performed for CH, with little benefit. Positron emission tomography (PET) using H2 150 as the tracer has shown a focal increase in cerebral blood flow in the ipsilateral posterior hypothalamic region during a CH attack (2, 3). Based on this finding, in 2000 a promising new surgical procedure for severe CH was introduced in Milan, Italy: chronic deep brain stimulation (DBS) of the posterior hypothalamic region (4). Three open-label case series have been published, two from European centers and a third from our own (5, 6, 7). Additional scattered case reports are beginning to emerge (8, 9). In the three case series, most patients received major benefit, but approximately 25% of patients were nonresponders.

Many aspects of this novel therapy remain to be elucidated, including the actual proportion of patients who respond favorably, the degree and duration of response, presurgical predictors of outcome, the mechanism of action, the time course of onset and washout of the therapeutic effect, optimal programming parameters, and the the safety of the procedure. Currently, no commercial DBS device has U.S. or European regulatory approval for this emerging indication. This chapter reviews the relevant features of CH, surgical indications for DBS, surgical techniques, clinical outcomes, and possible mechanism of action.

Keywords

cluster headache deep brain stimulation hypothalamus stereotactic neurosurgery 

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Copyright information

© Humana Press, a part of Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Philip A. Starr
    • 1
  • Andrew Ahn
    • 1
  1. 1.Department of NeurosurgeryUniversity of CaliforniaSan FranciscoUSA

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