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  • The Treatment of Chronic Cluster Headache with Deep Brain Stimulation of the Posterior Hypothalamus

    Final Number:

    Nilson N. Mendes Neto MS; Jessika Thais da Silva Maia; Juliano Jose da Silva MD; Sergio MD Adrian Fernandes Dantas; Marcelo Rodrigues Zacarkim MD; Daniel Duarte Rolim; Erich T. Fonoff MD, PhD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Studies using functional MRI showed the ipsilateral posterior hypothalamus activation during the cluster headache (CH) episodes. The deep brain stimulation of the posterior hypothalamic (DBS-PH) area was introduced in 2000 in order to treat drug-resistant chronic cluster headache (CCH).

    Methods: Systematic Research (SR) using databases including Pubmed, Medline and Cochrane were searched from inception to September 2017. Keywords “Chronic Cluster Headache”, “Deep Brain Stimulation” and “Hypothalamic Stimulation” were used. Plus, we contacted the authors of the included articles to provide unpublished data and to update the follow-up data. Data extraction was performed independently by two reviews. We followed the PRISMA checklist for SR.

    Results: 98 CCH cases have been treated with DBS-PH. Median follow-up time was 21.2 months. The study with the largest number of patients (n = 19) has the highest follow-up time, totalizing 104 months. Only one patient had the follow-up time lower than 1 year (8.4 months). Out of 98 cases, 28 patients reported pain-free and 38 patients obtained 50% reduction of headache intensity/frequency. Unsatisfactory results were shown in approximately one-third cases. In the group of 19 patients and the highest follow-up time (n=19), 2/3 had satisfactory results: 6 patients were pain-free and 6 patients had at least 50% reduction in headache intensity/frequency. Adverse effects such as increased appetite, insomnia, infection and dizziness were reported. One fatal case was reported due to cerebrovascular accident.

    Conclusions: Most patients (2/3) achieved a satisfactory and long-lasting pain reduction. Side effects were minor, transient and it could be easily managed. This treatment modality give hope for improvements to the therapy of cluster headache, although it should be administered when other non-invasive methods fail to treat CCH. Limits in our results are due to incomplete information in the case descriptions.

    Patient Care: These treatment modalities give hope for improvements to the therapy of cluster headache, although they should be administered according to current guidelines in centers in the context of prospective studies.

    Learning Objectives: To provide the current number of CCH patients treated with DBS-PH and the efficacy of treatment.


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