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Deep Brain Stimulation for Chronic Cluster Headaches: A Systematic Review and Meta-Analysis
Molly Murray1, Peter A Pahapill2, Ahmed J Awad2,3
1Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Stereotactic and Functional Neurosurgery
|May 28, 2023
Summary
Deep brain stimulation (DBS) is a feasible treatment for chronic cluster headache (CCH), offering significant reductions in headache frequency and intensity. This surgical approach demonstrates a reasonable safety profile, with approximately 70% of carefully selected patients achieving excellent headache control.
Area of Science:
- Neurology
- Neurosurgery
- Pain Management
Background:
- Chronic cluster headache (CCH) is a severe, debilitating headache disorder often resistant to medical treatments.
- CCH significantly impairs patients' quality of life.
- Deep brain stimulation (DBS) shows promise for CCH but lacks comprehensive systematic review.
Approach:
- A systematic literature review and meta-analysis were conducted following PRISMA 2020 guidelines.
- Data from 16 studies encompassing 108 patients with CCH treated with DBS were analyzed.
- A random-effects model was employed to assess safety and efficacy outcomes.
Key Points:
- DBS is highly feasible (>99%) for CCH, performable awake or asleep.
- Meta-analysis showed statistically significant reductions in headache attack frequency and intensity (p < 0.0001).
- Microelectrode recording utilization correlated with improved postoperative headache intensity (p = 0.006).
- Average follow-up was 45.4 months; mortality was <1%, with a 16.67% major complication rate.
Conclusions:
- DBS is a feasible surgical option for CCH with a reasonable safety profile.
- The procedure can be successfully performed in awake or asleep patients.
- Approximately 70% of carefully selected CCH patients achieve excellent headache control with DBS.
