Establishing the Role of Deep Brain Stimulation in the Treatment of Intractable Cluster Headache

T. Aziz, S.L.F. Owen & P. Davies

Cluster headache is one of the most painful of the primary headache syndromes. Respite from the pain comes for months or years in the episodic form of the condition. If there are cluster headache attacks for more than 1 year without remission, or with remissions lasting less than 1 month, it is called chronic cluster headache. This form makes up about 15% of cluster headache. It occurs de novo, primary chronic cluster headache, in about 10% of cases and is secondary to the episodic form in about 5%. The prognosis of the condition has not been studied in detail but J. Keith Campbell summarised it as: “chronic cluster headache is often difficult to treat medically and, once established, tends to persist for years”.
Not surprisingly various invasive and surgical procedures have been tried. In this paper we will briefly look at some of the surgical options and concentrate on how we might establish the role for deep brain stimulation (DBS) – a procedure that is well established in our unit.

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