Posterior Hypothalamic Stimulation in Chronic Cluster Headache

Authors: Nilson Nogueira Mendes Neto, Jessika Thais da Silva Maia, Daniel Duarte Rolim, Marcelo Rodrigues Zacarkim, Juliano Jose da Silva, Levi Higino Jales Junior, Servulo Marciano Pinheiro de Souza, Sebastiana Jayne Alves Vidal, Tatyana Vidal Mendes, Sergio Adrian Fernandes Dantas and Erich Talamoni Fonoff
Source: Neurology April 18, 2017 vol. 88 no. 16 Supplement P2.173


Objective: To provide data on the current number of CCH patients treated with stimulation of the posterior hypothalamus, the efficacy of treatment and side effects.

Background: 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.

Design/Methods: Systematic review using databases including Pubmed, Medline and Cochrane were searched from inception to April 2016. Keywords “Chronic Cluster Headache”, “Deep Brain Stimulation” and “Hypothalamic Stimulation” were used. Data extraction was performed independently by two reviews

Results: There were 70 CCH cases treated with stimulation of the posterior hypothalamus. 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 70 cases, 23 patients reported pain-free and 23 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 or frequency. Adverse effects such as increased appetite, insomnia, infection, dizziness, concentration problems and syncope have been reported. One fatal case was reported due to cerebrovascular accident.

Conclusions: The majority of patients (2/3) achieved a satisfactory and long-lasting pain reduction. Result’s discrepancy can be explained by the heterogeneity or absence of protocols in the posterior hypothalamus stimulation and patient’s individuality. Posterior hypothalamus simulation should be taken in consideration only when other non-invasive methods fail to treat CCH.

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