gms | German Medical Science

Objective: Cluster headache (CH) is characterized by frequent short-lasting attacks of pain localized in the orbital, supraorbital and/or temporal area. Deep brain stimulation (DBS) of the ipsilateral posterior hypothalamus has been shown to be effective in patients with chronic refractory cluster headache. We report the results of evaluation of long-term follow-up after chronic DBS.

Method: In three men with severe unilateral cluster headache DBS of the posterior hypothalamus was performed after preoperative evaluation and pain assessment. Electrodes were implanted stereotactically (model 3389, Medtronic, MN, USA) in the ipsilateral posterior hypothalamus with microelectrode guidance. Long-term follow-up was achieved up to 72 months.

Results: In two patients, both intensity and frequency of the attacks were reduced (frequency 80%, intensity 70%) after surgery, whereas in one patient there was no significant change. Long-term evaluation at 72 and 86 months postoperatively in the first two patients showed sustained significant pain reduction (80% of frequency, 70% of pain intensity). The stimulation parameters for deep brain stimulation were: 1,4-4,4 V, 130 Hz, 60µs, bipolar stimulation. However, in one patient CH reoccurred on the other side 86 months after the initial treatment. After detailed assessment a second electrode was implanted in the posterior hypothalamus ipsilateral, resulting in a significant reduction of pain attacks and intensity of 50% postoperatively. In a second patient frontal headache without attacks or vegetative symptoms developed in 2013. MRI scan showed a frontal cortical tumor. The tumor was successfully removed.

Conclusions: DBS in the posterior hypothalamus is an effective therapeutic option for selected patients with chronic refractory cluster headache at long-term follow-up.