Chronic Cluster Headache (CCH) is the most severe and disabling primary headache. Studies using functional magnetic resonance imaging showed the ipsilateral posterior hypothalamus activation during the cluster headache episodes. The Deep Brain Stimulation (DBS) of the posterior hypothalamic area was introduced in 2000 in order to treat drug-resistant chronic cluster headache.
Hemicrania continua (HC) is characterised by a strictly unilateral continuous headache with ipsilateral autonomic features and migrainous symptoms that is exquisitely sensitive to indomethacin.1 As more than 30% of patients report side effects with indomethacin, there is need for an effective and safe alternative. Although several drugs have been used in open-label studies, none offer the same magnitude of response.
Cluster headache is a rare form of primary headache characterised by intense unilateral pain and autonomous nerve symptoms. Pharmacological treatments are sometimes insufficient, which calls for surgical alternatives in treatment refractory cases. Stimulation of the sphenopalatine ganglion (SPG) is a new method shown to be effective for preventing and treating attacks.
In the PREVention and Acute treatment of chronic cluster headache (PREVA) study, attack frequency reductions from baseline were significantly more pronounced with non-invasive vagus nerve stimulation plus standard of care (nVNS + SoC) than with SoC alone. Given the intensely painful and frequent nature of chronic cluster headache attacks, additional patient-centric outcomes, including the time to and level of therapeutic response, were evaluated in a post hoc analysis of the PREVA study.
The trigeminal autonomic cephalalgias (TACs) are highly disabling primary headache disorders. There are several issues that remain unresolved in the understanding of the pathophysiology of the TACs, although activation of the trigeminal–autonomic reflex and ipsilateral hypothalamic activation both play a central role. The discovery of the central role of the hypothalamus led to its use as a therapeutic target. After the good results obtained with hypothalamic stimulation, other peripheral neuromodulation targets were tried in the management of refractory cluster headache (CH) and other TACs.