Deep brain stimulation in headache.

Abstract

BACKGROUND:

Deep brain stimulation of the posterior hypothalamic area was first introduced in 2000 to treat drug-refractory chronic cluster headache (CH).

FINDINGS:

So far, hypothalamic stimulation has been employed in 79 patients suffering from various forms of intractable short-lasting unilateral headache forms, mainly trigeminal autonomic cephalalgias. The majority were (88.6%) chronic CH, including one patient who suffered from symptomatic chronic CH-like attacks; the remaining were short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), one had paroxysmal hemicranias and one symptomatic trigeminal neuralgia. Overall, after a mean follow up of 2.2 years, 69.6% (55) hypothalamic-stimulated patients showed a ≥50% improvement.

CONCLUSIONS:

These observations need confirmation in randomised, controlled trials. A key role of the posterior hypothalamic area in the pathophysiology of unilateral short-lasting headaches, possibly by regulating the duration rather than triggering the attacks, can be hypothesised. Because of its invasiveness, hypothalamic stimulation can be proposed only after other, less-invasive, neurostimulation procedures have been tried.

• Authors: Massimo Leone, Alberto Proietti Cecchini
• Journal: Cephalalgia : an international journal of headache (Cephalalgia) Vol. 36 Issue 12 Pg. 1143-1148 (Oct 2016) ISSN: 1468-2982 [Electronic] England
• PMID: 26646787 (Publication Type: Journal Article, Review)

Topics

• Deep Brain Stimulation (methods)
• Evidence-Based Medicine
• Headache (diagnosis, therapy)
• Humans
• Hypothalamus
• Treatment Outcome