Stereotactic Radiosurgery for Cluster Headache: A Single Center Retrospective Study

Trigeminal autonomic cephalalgias are rare primary headache disorders. Cluster headache (CH) is the most common form. Stereotactic radiosurgery (SRS) is sometimes used in medically refractory cases. This study was designed to evaluate the efficacy of SRS for the management of CH, with specific goals to assess the duration of pain relief, the recurrence rate, and the occurrence of sensory complications.

A retrospective study of patients who underwent SRS at our institution for CH between 2004 and 2022 was conducted. Baseline demographics, symptoms, and pain characteristics were collected before treatment. Symptoms, pain evolution, and complications were obtained at follow-up. Outcomes were analyzed using the Kaplan-Meier method and descriptive statistics.

The cohort included 18 patients. One patient had bilateral pain and was treated sequentially on both sides. Both trigeminal nerve and sphenopalatine ganglion were targeted using a median maximum dose of 80 Gy. SRS yielded adequate pain control (modified Barrow Neurological Institute IIIb or better) in 79% of cases after a median of 4 months. Pain recurred after a median of 27 months in 80% of patients who had initial relief. Repeat SRS for recurrence was effective in 4 of 5 patients. New bothersome facial numbness (Barrow Neurological Institute III or worse) occurred in 16% after primary SRS and 50% after repeat SRS.

SRS is a reasonable management option for refractory CH. Most patients will see at least transient improvement in pain attacks, but recurrence is common. Rates of bothersome numbness appear lower than previously reported after a single SRS procedure for CH.