Deep brain stimulation of chronic cluster headaches: Posterior hypothalamus, ventral tegmentum and beyond.

ObjectiveWe present long-term follow-up results and analysis of stimulation sites of a prospective cohort study of six patients with chronic cluster headaches undergoing deep brain stimulation of the ipsilateral posterior hypothalamic region.MethodsThe primary endpoint was the postoperative change in the composite headache severity score “headache load” after 12 months of chronic stimulation. Secondary endpoints were the changes in headache attack frequency, headache attack duration and headache intensity, quality of life measures at 12, 24, and 48 months following surgery. Stimulating contact positions were analysed and projected onto the steroetactic atlas of Schaltenbrand and Wahren.ResultsThere was a significant reduction of headache load of over 93% on average at 12 months postoperatively that persisted over the follow-up period of 48 months (p = 0.0041) and that was accompanied by a significant increase of reported quality of life measures (p = 0.03). Anatomical analysis revealed that individual sti...