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Cluster Headache: Deep Brain Stimulation

  • Harith AkramEmail author
  • Ludvic Zrinzo
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Abstract

Cluster headache (CH) is an entity of trigeminal autonomic cephalalgia with a prevalence of 0.1–0.2%. Ten to 15% of patients have a chronic form (CCH), at times intractable to medical therapies. In these patients, peripheral and central neuromodulation can provide another treatment modality. DBS in the ventral tegmental area (VTA) has been shown to be a safe and effective therapy for refractory CCH patients who failed conventional treatments. To date, over 120 patients have been reported in the literature since the first case report in 2001.

This chapter discusses the pathophysiology of CH; the role neuromodulation can play in the treatment of the chronic, medically refractory form of the disease; patient selection; surgical procedure; DBS programming; and approaches to evaluating outcome. Target connectivity and brain networks are discussed with a focus on DBS mechanism of action.

Keywords

Deep brain stimulation (DBS) Cluster headache (CH) Trigeminal autonomic cephalalgia (TAC) Ventral tegmental area (VTA) Posterior hypothalamus (PH) Tractography Trigemino-hypothalamic tract (THT) Facial pain Headache load (HAL) 

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Authors and Affiliations

  1. 1.Unit of Functional NeurosurgeryUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUK

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