According to a study published in Cephalalgia, deep brain stimulation (DBS) to treat chronic cluster headache effectively reduced headache severity over 90% on average, which was maintained during long-term follow-up. In addition, DBS likely benefits a wider neuroanatomical area than the posterior hypothalamic region.
The study cohort included 6 patients with chronic cluster headache who experienced highly disabling, medically refractory symptoms for a minimum of 2 years. Participants underwent DBS implantation surgery and were followed up regularly for 48 months. Stimulating contact positions were analyzed and projected onto the stereotactic atlas of Schaltenbrand and Wahren.
The primary study end point was the postoperative change in composite headache severity score following 12 months of chronic stimulation. Secondary end points were changes in headache attack frequency, duration and intensity, and quality of life measured at 12, 24, and 48 months following surgery.
At 12 months, a significant reduction of headache severity, or headache load, was reported: the preoperative headache load was 10,045 (95% CI, 3360-20,160) and was reduced to 780 (95% CI, 0-4080; P =.03) at 12 months. Of 6 participants, 5 achieved a reduction of over 90% and only 1 achieved a reduction of 44%. These headache load reductions persisted over the 48-month follow-up period (P =.0041).
The cohort also reported a significant increase in quality of life measures (P =.03); similar improvement was reported for the frequency, duration, and intensity of headache attacks. Anatomical analysis of stimulating contact positions revealed locations in the red nucleus, posterior hypothalamic region, mesencephalic pretectal area, and centromedian nucleus of the thalamus.
Limitations to the series include small sample size, and findings may not be generalized to a broader population. Headache load was determined from 1-week pain diaries kept by the participants and may not reflect headache reductions over the course of a year. Electrode positions were projected onto a stereotactic atlas and no systematic modeling of stimulation volumes was performed, nor was a connectivity analysis of stimulation sites performed.
The investigators indicate that DBS to treat chronic cluster headache is efficacious in the long-term, with a significant reduction of headache load achieved after 12 months and maintained over 48 months. Furthermore, they suggest that headache relief from DBS is likely not restricted to the posterior hypothalamic area but may benefit a wider neuroanatomical region.
Nowacki A, Moir L, Owen SL, Fitzgerald JJ, Green AL, Aziz TZ. Deep brain stimulation of chronic cluster headaches: posterior hypothalamus, ventral tegmentum and beyond [published online March 21, 2019]. Cephalalgia. doi: 10.1177/0333102419839992