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Optimal deep brain stimulation site and target connectivity for chronic cluster headache
Harith Akram1, Sarah Miller2, Susie Lagrata2
1From the Unit of Functional Neurosurgery (H.A., M.H., L.Z.), Sobell Department of Motor Neuroscience and Movement Disorders, and Wellcome Trust Centre for Neuroimaging (J.A., T.B.), UCL Institute of Neurology, University College London; Victor Horsley Department of Neurosurgery (H.A., L.Z.), National Hospital for Neurology and Neurosurgery; Headache Group (S.M., S.L., M.M.), UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK; Department of Clinical Neuroscience (M.H.), Umeå University, Sweden; and Centre for Functional MRI of the Brain (T.B.), John Radcliffe Hospital, Oxford, UK. Harith.akram.12@ucl.ac.uk.
Deep brain stimulation (DBS) effectively treats chronic cluster headache by targeting the ventral tegmental area. This study identified the optimal stimulation site and its connection to pain pathways, improving treatment mechanisms.
Area of Science:
- Neuroscience
- Neurosurgery
- Pain Medicine
Background:
- Chronic cluster headache is a debilitating neurological disorder.
- Refractory cases often lack effective treatment options.
- Deep brain stimulation (DBS) is an emerging therapy.
Purpose of the Study:
- To determine the optimal ventral tegmental area (VTA) target for DBS in chronic cluster headache.
- To elucidate the mechanism of action of VTA DBS for this condition.
Main Methods:
- Seven patients with refractory chronic cluster headache underwent MRI-guided VTA electrode implantation.
- Diffusion MRI and voxel-based morphometry analyzed tissue activation and connectivity.
- Finite-element modeling generated volumes of tissue activation.
Main Results:
- Significant reductions in headache load (76%), severity (46%), frequency (58%), and duration (51%) were observed.
- Six of seven patients responded to DBS.
- Optimal VTA activation correlated with the trigeminohypothalamic tract.
Conclusions:
- The study identifies a precise VTA stimulation target for chronic cluster headache.
- DBS modulates pain via the trigeminohypothalamic tract, offering insights into disease pathophysiology.
- This research advances understanding and treatment of refractory cluster headache.