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Treatment Options for Cluster Headaches
The Role of Surgery for Cluster Headaches
- Temporary postoperative epistaxis (bleeding)
- Cheek hematoma (bruising of the cheek)
- Hypesthesia of the palate (impairment or decrease of sensitivity)
Most of the procedures directed at autonomic pathways are not associated with long-lasting pain relief and can actually lead to significant long-term complications (e.g., double vision, hyperacusia/abnormal intolerance of loud sounds, corneal anesthesia). For this reason, all patients undergoing these procedures require ophthalmic follow-up. Also, the headaches may recur on the opposite side of the head and they are as intense if not worse than before surgery.
New Surgical Treatments for Cluster Headaches
Greater Occipital Nerve Blockade
In a very limited number of patients suffering from chronic cluster headache, blockade of the greater occipital nerve yielded promising results. Further investigation is underway. You can read more about greater occipital nerve injection by clicking on the following link:
Hypothalamic Deep Brain Stimulation
Hypothalamic deep brain stimulation is a very exciting but truly investigational surgical treatment for severe, intractable, chronic cluster headache that has been studied by an Italian group of researchers. Recent studies have shown that during a cluster headache attack, there is an actual difference in the density of brain tissue in a specific area of the hypothalamus. Based upon imaging studies showing that the hypothalamus is activated during cluster headache attacks and, indeed, may be a generator of cluster headache, stereotactic stimulation of this area may interfere with the onset of cluster headache. A stimulator was placed into the hypothalamus of 6 study patients with refractory chronic cluster headache to see if stimulating the hypothalamus could stop a patient from having cluster headaches. The researchers found that once the stimulator was turned on, the cluster headaches started to disappear. In some patients pain relief was immediate, while in others it took up to 4 months for patients to become pain free. When the stimulator was turned off, the attacks resumed, though not immediately. So far the patients have had no side-effects with the stimulator. Preliminary results indicate that at 42 months post surgery, some patients remain pain free.
This treatment is completely experimental at present and must be performed by a highly skilled and experienced neurosurgeon. Close follow-up after the procedure is required. Hypothalamic stimulation is still new and needs to be studied for further safety issues. Some patients report transient vertigo or bradycardia (slow heart rate) while stimulation is in process but most patients tolerate the procedure well. Subsequent studies have reported success in a total of 16 patients with intractable chronic cluster headache after being followed for four years. None of the patients developed any numbness or reduction of feeling in the trigeminal nerve.
To read more about hypothalamic stimulation, click on the following links:
