Drug-Resistant Cluster Headache: Long-Term Evaluation of Pain Control by Posterior Hypothalamic Deep-Brain Stimulation

Objective On the basis of recent findings about the pathophysiology of cluster headache and through the experience reported in recent literature, we have reviewed the outcome of four patients affected by drug-resistant cluster headache treated in our department by posterior hypothalamic deep brain stimulation with a follow-up of more than 5 years. Methods Between 2004 and 2006, we selected four patients affected by cluster headache. The diagnosis was based on the International Classification of Headache Disorders II criteria, and all patients were refractory to drug therapy. Under local anesthesia they underwent stereotactic positioning of a stimulation electrode within the posterior hypothalamus, ipsilateral to the site of pain. An intraoperative neurophysiological test stimulation was performed to assess possible side effects and symptoms related to hypothalamic neuronal activity. A second surgery was then performed with the patient under general anesthesia to implant the extension cable and the implantable pulse generator. Results After 5 years of follow up, all patients had a valuable benefit with a reduction in episode frequency from 90% to 50% associated with a decrease in pain intensity perception. Conclusion The long-lasting pain reduction and the improvement in the patients' symptoms should be considered a real positive prospective, not only because there was uncertainty about the persistence of the beneficial effects at a long-term follow-up, but also for the improvement of the quality of life. The stimulation can restore important aspects concerning the psychic condition that very often constitutes an important limiting factor in normal daily life for this type of patient.