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Deep brain stimulation for medically intractable cluster headache.

Karl A Sillay1, Sepehr Sani, Philip A Starr

  • 1Department of Neurosurgery, University of Wisconsin, Madison, WI 53792, USA. k.sillay@neurosurg.wisc.edu

Neurobiology of Disease
|June 9, 2009
PubMed
Summary
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Deep brain stimulation (DBS) shows promise for intractable cluster headache, but its role as a first-line therapy is debated. Occipital nerve stimulation is an emerging alternative surgical option.

Area of Science:

  • Neurology
  • Neurosurgery

Background:

  • Cluster headache is a severe primary headache disorder.
  • 10-20% of cases are medically intractable, necessitating advanced treatments.
  • Posterior hypothalamic area stimulation has been explored for intractable cases.

Purpose of the Study:

  • To review the indications, techniques, and outcomes of deep brain stimulation (DBS) for cluster headache.
  • To discuss the evolving role of DBS in light of newer surgical options.

Main Methods:

  • Review of reported cases of DBS for cluster headache from European centers and the University of California, San Francisco.
  • Discussion of the neuroimaging findings (H(2)(15)O PET scans) that informed the surgical target.
  • Consideration of occipital nerve stimulation as an alternative therapy.

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Main Results:

  • Deep brain stimulation (DBS) has demonstrated effectiveness in alleviating cluster headache in a significant portion of reported cases.
  • The surgical target for DBS is located in the posterior hypothalamic area, guided by PET scan findings.
  • Efficacy of DBS varies, and newer techniques like occipital nerve stimulation are emerging.

Conclusions:

  • Deep brain stimulation (DBS) is a viable surgical option for medically intractable cluster headache.
  • The emergence of occipital nerve stimulation warrants a re-evaluation of DBS as a first-line surgical treatment.
  • Further research is needed to define the optimal surgical strategy for cluster headache.