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Deep Brain Stimulation for Medically Intractable Cluster Headache

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Deep Brain Stimulation in Neurological and Psychiatric Disorders

Part of the book series: Current Clinical Neurology ((CCNEU))

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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 (5–7). 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.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, University of California, San Francisco, CA, USA

    Philip A. Starr & Andrew Ahn

Authors
  1. Philip A. Starr
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  2. Andrew Ahn
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Editor information

Editors and Affiliations

  1. Parkinson's Disease and Movement Disorders Center, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Daniel Tarsy MD  & Daniel Tarsy MD  & 

  2. Neuromodulation Research Center, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA

    Jerrold L. Vitek MD, PhD

  3. Department of Neurosurgery, University of California, San Francisco, CA, USA

    Philip A. Starr MD, PhD

  4. Departments of Neurology and Neurosurgery, McKnight Brain Institute, University of Florida, Gainesville, FL, USA

    Michael S. Okun MD

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

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Starr, P.A., Ahn, A. (2008). Deep Brain Stimulation for Medically Intractable Cluster Headache. In: Tarsy, D., Vitek, J.L., Starr, P.A., Okun, M.S. (eds) Deep Brain Stimulation in Neurological and Psychiatric Disorders. Current Clinical Neurology. Humana Press. https://doi.org/10.1007/978-1-59745-360-8_27

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  • DOI: https://doi.org/10.1007/978-1-59745-360-8_27

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-952-9

  • Online ISBN: 978-1-59745-360-8

  • eBook Packages: MedicineMedicine (R0)

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