Previous Section
Treatment Options for Cluster Headaches
The Role of Surgery for Cluster Headaches
No one yet knows, however, the true delayed complications of gamma knife, especially in young patients. Gamma knife radiosurgery is being used for cluster headache treatment by some headache centers and the impression is that it works initially, but there are high relapse rates (return of cluster pain) questioning if this treatment strategy is indeed useful in cluster headache.
In 2005, a study of gamma knife radiosurgery was carried out on 10 patients with severe and drug resistant chronic cluster headache. The results of the study were mixed and the authors concluded that the pain relief noted in some of the subjects may be outweighed by the potential treatment complications. To read more about this study, please click on the following link:
Microvascular Decompression
Microvascular decompression involves exposing the vascular system in the region of the trigeminal nerve via craniectomy (creating a small opening in the skull). The objective is to ascertain if there are any vascular loops pressing on the nerve which may be causing the pain and to restore the layout of the blood vessels to their proper anatomical position.
When performed either alone or combined with section of the nervus intermedius and followed up for 5 years, approximately 73% of patients undergoing neurovascular decompression for the first time reported pain relief of 50% or greater. In approximately 15% of the patients, 90% or greater pain relief was achieved. Of patients undergoing the procedure for the first time, approximately 80% were found to have vascular compression of the trigeminal nerve.
Procedures Targeted at Autonomic Pathways
- Sectioning (cutting) of the greater superficial petrosal nerve
- Sectioning of the nervus intermedius
- Blockade of the sphenopalatine ganglion by radiofrequency
Sectioning of the Greater Superficial Petrosal Nerve
The greater superficial petrosal nerve connects into a ganglion which gives off nerve branches that supply the lacrimal (tear) gland and the mucous secreting glands of the nasal and oral cavities. Sectioning this nerve is intended to reduce the autonomic symptoms, (e.g., tearing, sweating) associated with cluster headache.
Sectioning of the Nervus Intermedius
In this procedure, a craniectomy (small opening of the skull) is performed and the 7th and 8th cranial nerves are exposed. The nervus intermedius is then sectioned. Some patients benefit from this procedure when combined with microvascular decompression of blood vessels in the region. In one study, five out of eight patients who underwent both procedures experienced recurrence of headaches within 4 months, however, the headaches were not as severe as before the surgery.
Adverse effects of surgery or complications may include:
- Hearing loss
- Facial palsy
- Loss of taste
- Vertigo
Blockade of the Sphenopalatine Ganglion by Radiosurgery
In a small study which investigated blockade of the sphenopalatine ganglion by radiosurgery and followed patients for up to 5 years, approximately 60% of the patients with episodic cluster headache and 40% of patients with chronic cluster headache experienced full pain relief for up to 2 years.
Adverse effects of this procedure include:
