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Neuromodulation in Cluster Headache

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Advances and Technical Standards in Neurosurgery

Part of the book series: Advances and Technical Standards in Neurosurgery ((NEUROSURGERY,volume 42))

Abstract

Medically refractory chronic cluster headache (CH) is a severely disabling headache condition for which several surgical procedures have been proposed as a prophylactic treatment. None of them have been evaluated in controlled conditions, only open studies and case series being available. Destructive procedures (radiofrequency lesioning, radiosurgery, section) and microvascular decompression of the trigeminal nerve or the sphenopalatine ganglion (SPG) have induced short-term improvement which did not maintain on long term in most of the patients. They carried a high risk of complications, including severe sensory loss and neuropathic pain, and consequently should not be proposed in first intention.

Deep brain stimulation (DBS), targeting the presumed CH generator in the retro-hypothalamic region or fibers connecting it, decreased the attack frequency >50 in 60 % of the 52 patients reported. Complications were infrequent: gaze disturbances, autonomic disturbances, and intracranial hemorrhage (2).

Occipital nerve stimulation (ONS) was efficient (decrease of attack frequency >50 %) in about 70 % of the 60 patients reported, with a low risk of complications (essentially hardware related). Considering their respective risks, ONS should be proposed first and DBS only in case of ONS failure.

New on-demand chronically implanted SPG stimulation seemed to be efficient to abort CH attacks in a pilot controlled trial, but its long-term safety needs to be further studied.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Centre Hospitalier Universitaire de Nice, Nice, France

    Denys Fontaine MD, PhD & Clair Vandersteen MD

  2. IGCN-EA 7282 (Image-Guided Clinical Neuroscience and Connectomics), UMR 6284 ISIT, UdA, Clermont-Ferrand, France

    Denys Fontaine MD, PhD

  3. Service de Neurochirurgie, Hôpital Pasteur, 30 avenue de la voie romaine, Nice, 06000, France

    Denys Fontaine MD, PhD

  4. Institut Universitaire de la face et du cou, Nice, France

    Clair Vandersteen MD

  5. Headache Research Unit, Department of Neurology, University of Liège, Liège, Belgium

    Delphine Magis MD, PhD

  6. Department d’Evaluation et Traitement de la Douleur, CHU de Nice, Nice, France

    Michel Lanteri-Minet MD

  7. Inserm U929, Clermont-Ferrand, France

    Michel Lanteri-Minet MD

Authors
  1. Denys Fontaine MD, PhD
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  2. Clair Vandersteen MD
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  3. Delphine Magis MD, PhD
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  4. Michel Lanteri-Minet MD
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Corresponding author

Correspondence to Denys Fontaine MD, PhD .

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Editors and Affiliations

  1. Medizinische Fakultät, Univ.Klinikum Bonn Med. Einrichtungen, Bonn, Germany

    Johannes Schramm

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Fontaine, D., Vandersteen, C., Magis, D., Lanteri-Minet, M. (2015). Neuromodulation in Cluster Headache. In: Schramm, J. (eds) Advances and Technical Standards in Neurosurgery. Advances and Technical Standards in Neurosurgery, vol 42. Springer, Cham. https://doi.org/10.1007/978-3-319-09066-5_1

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  • DOI: https://doi.org/10.1007/978-3-319-09066-5_1

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