Exploring the potential of deep brain stimulation in managing cluster headache: a systematic review

The debilitating nature of cluster headache (CH) is typified by intense, repeated cephalgia that are often referred to as "suicide headaches" owing to their severity. Individuals may not respond appropriately to therapeutic interventions despite various alternatives being readily available. This warrants an investigation into further management options. One of the promising solutions for CH has been identified as deep brain stimulation (DBS), which specifically targets the posterior hypothalamus.

This systematic review aims to summarize the current literature on the safety and efficacy of DBS in the management of CH.

A comprehensive literature search identified 15 relevant studies comprising clinical trials, case reports, and observational studies from Embase, Web of Science, PubMed/MEDLINE, Scopus, and the Cochrane Library using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 standards.

The systematic review elucidated that DBS, with a focus on the posterior hypothalamus, facilitated significant reductions in the frequency, severity, and duration of cephalgic 'attacks' associated with CH observed. While individual responses varied, DBS was generally well-tolerated, with transient and reversible adverse effects involving focal neurological deficits (i.e., diplopia) being the most common. Importantly, long-term benefits were observed in vast populations, improving their overall quality of life. Furthermore, DBS demonstrated effects beyond localized hypothalamic stimulation, with evidence suggesting modulation of the pain processing network. Additionally, DBS was found to alleviate nocturnal CH attacks without disrupting circadian rhythms. These findings suggest that DBS holds promise as a therapeutic option for CH, particularly in individuals refractory to other treatments.

Existing research suggests that DBS, particularly when targeting the posterior hypothalamus, can significantly reduce CH 'attack' frequency, severity, and duration. Further research should focus on patient selection criteria and a deeper understanding of the mechanisms underpinning DBS to optimize its effectiveness in managing such a disabling cephalgia.