Table 3 Preventive treatments for cluster headache
From: Imaging the brain and vascular reactions to headache treatments: a systematic review
Reference | Population | Treatment | Imaging modality and timing of scans | Results | Limitations |
|---|---|---|---|---|---|
May et al., 2006 [40] | 10 CCH | Type: Hypothalamic DBS stimulation Duration: 60 s of stimulation | Modality: H215O-PET Time-point: Single-scan obtained with and without DBS stimulation | Stimulation vs no stimulation: ↑ Activation during stimulation in the ipsilateral hypothalamus, thalamus, trigeminal nucleus and ganglion, precuneus, somatosensory, and anterior cingulate cortex ↓ Activation during stimulation in the bilateral middle temporal gyrus, posterior cingulate cortex, inferior temporal gyrus, and contralateral anterior insula | Uncorrected results and small volume correction for a priori selected ROIs Five patients were taking other preventive medications No information regarding the cluster headache phase (in bout or out of bout) and the presence of headache the day of the PET scan |
Magis et al., 2011 [41] | 10 CCH (drug-resistant) (7 responders and 3 non-responders) 39 HC | Type: Occipital nerve stimulation Duration: 6–30 months | Modality:18FDG PET Time-point: Before treatment, after 1 month and after 6 months of treatment (6 CH) After 24 to 30 months after treatment (4 CH) HC underwent only one PET scan | CCH vs HC: ↑ metabolism in the ACC, left hypothalamus, left pulvinar, left visual cortex, cerebellum and brain stem in CCH compared to HC ↓ metabolism in bilateral sensorimotor areas in CCH compared to HC Baseline-to-follow-up (after 1 month): No significant changes Baseline-to-follow-up (after ≥ 6 months): ↓ metabolism in bilateral cingulate cortex, left visual cortex, pulvinar, midbrain and pons, ↑ metabolism in bilateral sensorimotor areas Follow-up: Responders vs non-responders ↑ metabolism in left perigenual ACC in responders compared to non-responders at follow-up | Small sample size |
Medina et al., 2021 [42] | 18 CH 7 HC | Type: Greater occipital nerve blockade with methylprednisolone 80 mg and 2 ml of lidocaine 2% Duration: Single blockade | Modality: ASL Time-point: Before and 7 days after treatment HC underwent only one MRI sca | Baseline: Patients vs HC ↑ rCBF in the cerebellum and left hippocampus in patients compared to HC ↓ rCBF in the right orbitofrontal cortex, rostral anterior insula and middle temporal gyrus in patients compared to HC Baseline-to-follow-up: ↑ rCBF in the right secondary visual cortices ↓ rCBF in the left medial temporal gyrus, cerebellum, caudate and putamen Baseline: Responders vs non-responders ↑ rCBF in the right lateral occipital cortex and left medial prefrontal cortex in responders compared to non-responders ↓ rCBF in the right posterior cingulate gyrus in responders compared to non-responders Follow-up: Responders vs non-responders ↓ rCBF in the left middle temporal cortex in responders compared to non-responders | Uncorrected results and small volume correction for a priori selected regions of interest |
Tso et al., 2021 [43] | 194 CH (105 non-responders, 89 responders) | Type: Verapamil (variable dosage) Duration: ≥ 3 months | Modality: T1w MRI Time-point: Before treatments | Baseline: Responders vs non-responders ↑ GM volume of the cerebellar vermis (FWE-corrected results) and bilateral cerebellar lobule VI (uncorrected results) in non-responders compared to responders A supervise machine learning model discriminated responders from non-responders with an accuracy of 66% based on clinical data, and of 68% based on combined clinical and imaging data | Patients with probable and post-traumatic cluster-headache included Data retrieved retrospectively from medical records Missing data on bout of patients No harmonization efforts to adjust for the use of different scanners |