EHMTI-0279. Deep brain stimulation for refractory chronic cluster headache

Introduction

Chronic cluster headache (CCH) is an excruciating, unilateral headache with recurrent episodes of severe pain associated with ipsilateral autonomic features. 10-20% of patients are refractory to medical management. We present a prospective cohort of 19 patients with intractable CCH treated with posterior hypothalamic deep brain stimulation (DBS).

Methods

Patients with refractory CCH referred to multidisciplinary headache clinic at our centre underwent DBS. Clinical data was collected pre and post-treatment. Headache load (HAL) (defined as [severity (on the visual analogue score)] x [duration] x [frequency] of headaches over a 2 week period) was calculated before and after treatment. A treatment response was identified as a 30% or more reduction in HAL.

Results

19 patients (M=15) with a median age of 48 years (33-67 years) underwent surgery. Median follow up time was 12 months (9-48 months). 17 patients had at least one year follow up. Five patients failed to respond to treatment but nine showed a reduction in HAL of more than 80%. Within three months of surgery, the median change in HAL was 62% (0-100%) and at twelve months was 69% (0-100%). Significant differences exist between HAL at baseline and at three (p=0.001) and twelve months (p=0.06). There were no serious adverse events. One patient reported persistent diplopia, which was due to decompensation of a long-standing third nerve palsy.

Conclusions

Posterior Hypothalamic DBS appears a safe and effective treatment for CCH and should be considered for suitable patients who fail conventional treatment.

No conflict of interest.