Massimo Leone1, Alberto Proietti Cecchini1. 1. Department of Neurology, Headache and Neurology Department and Pain Neuromodulation Unit, Fondazione Istituto Nazionale Neurologico Carlo Besta, Italy.
Abstract
BACKGROUND: Deep brain stimulation of the posterior hypothalamic area was first introduced in 2000 to treat drug-refractory chronic cluster headache (CH). FINDINGS: So far, hypothalamic stimulation has been employed in 79 patients suffering from various forms of intractable short-lasting unilateral headache forms, mainly trigeminal autonomic cephalalgias. The majority were (88.6%) chronic CH, including one patient who suffered from symptomatic chronic CH-like attacks; the remaining were short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), one had paroxysmal hemicranias and one symptomatic trigeminal neuralgia. Overall, after a mean follow up of 2.2 years, 69.6% (55) hypothalamic-stimulated patients showed a ≥50% improvement. CONCLUSIONS: These observations need confirmation in randomised, controlled trials. A key role of the posterior hypothalamic area in the pathophysiology of unilateral short-lasting headaches, possibly by regulating the duration rather than triggering the attacks, can be hypothesised. Because of its invasiveness, hypothalamic stimulation can be proposed only after other, less-invasive, neurostimulation procedures have been tried.
BACKGROUND: Deep brain stimulation of the posterior hypothalamic area was first introduced in 2000 to treat drug-refractory chronic cluster headache (CH). FINDINGS: So far, hypothalamic stimulation has been employed in 79 patients suffering from various forms of intractable short-lasting unilateral headache forms, mainly trigeminal autonomic cephalalgias. The majority were (88.6%) chronic CH, including one patient who suffered from symptomatic chronic CH-like attacks; the remaining were short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), one had paroxysmal hemicranias and one symptomatic trigeminal neuralgia. Overall, after a mean follow up of 2.2 years, 69.6% (55) hypothalamic-stimulated patients showed a ≥50% improvement. CONCLUSIONS: These observations need confirmation in randomised, controlled trials. A key role of the posterior hypothalamic area in the pathophysiology of unilateral short-lasting headaches, possibly by regulating the duration rather than triggering the attacks, can be hypothesised. Because of its invasiveness, hypothalamic stimulation can be proposed only after other, less-invasive, neurostimulation procedures have been tried.
Entities:
Keywords:
Deep brain stimulation; SUNCT; cluster headache; drug resistant; hypothalamic stimulation; intractable; neurostimulation; paroxysmal hemicrania; trigeminal autonomic cephalalgias; trigeminal neuralgia
Authors: Cherubino Di Lorenzo; Gianluca Coppola; Davide Di Lenola; Maurizio Evangelista; Giulio Sirianni; Paolo Rossi; Giorgio Di Lorenzo; Mariano Serrao; Francesco Pierelli Journal: Front Neurol Date: 2018-02-12 Impact factor: 4.003