[Neurosurgical treatment of headaches]

Apart from headaches due to expanding lesions or vascular abnormalities which require a direct neurosurgical approach, some cases of untractable, acute or chronic headaches may need some neurosurgical management. Among these, "low pressure hydrocephalus" is responsible for a number of cases that can be relieved by ventriculo-atrial or ventriculo-peritoneal shunts: "dural headaches" including some atypic migraines and "cluster headaches" can be cured by sectioning of the afferent meningeal rootlet of the trigeminal nerve in its retrogasserian portion. Some occipital types of headache, "venous headache" or "strain headache", may benefit of a cross section of the occipital dura mater. The Authors have also used in selected cases of untractable headache, their technique of intermittent electrical stimulation of the nucleus ventralis posterolateralis by means of an implanted stimulator.