Small Study Suggests Promising Role for Deep Brain Stimulation Surgery to Treat Intractable Cluster Headache

Thursday, May 03, 2007

BOSTON — A new application for deep brain stimulation (DBS), a 10-year-old advanced surgical treatment, could be to reduce cluster headache occurrences, according to Mayo Clinic neurologists. They cite the case of a 51-year-old man who suffered about 100 disabling cluster headaches every month for two years — an average of 3.5 a day, despite high doses of medications intended to control them. Now, he has 0 to 30 attacks a month as the result of this new application of deep brain stimulation.

Mayo Clinic neurosurgeons implanted an electrical stimulation device in the hypothalamus area of the man's brain during DBS surgery more than two years ago. In addition to a significant reduction in headaches, the man has been headache free for as long as 28 days on two occasions. His attacks vary month to month, and he still requires other medications. Mayo Clinic neurologists on May 3 presented the preliminary results of this novel application of DBS at the annual meeting of the American Academy of Neurology.

In addition to the case of the 51-year-old man, the Mayo Clinic team presented similarly encouraging results from a 37-year-old patient whose headaches declined from 60 per month to 5-15 per month after DBS. Physicians caution, however, that the small sample size of two patients limits the immediate widespread application of DBS for cluster headaches.

Significance of the Mayo Clinic Study

David Black, M.D., a neurologist at Mayo Clinic in Rochester, Minn., led the study. He explained its importance: "Medications certainly remain the mainstay of treatment; however, in those patients whose attacks do not respond to medications, DBS may be a well-tolerated option that significantly reduces pain and suffering. It is not a cure, but compared with our previous options of surgical techniques aimed at destroying the nerve involved, DBS may offer better results with fewer side effects. While further study is needed, our preliminary results in these two patients are noteworthy because they support earlier pilot studies for cluster headache that show DBS to be a safe and effective approach in select cases. If these early results hold up in future studies, DBS appears to offer a chance for a return to a normal life."

About Deep Brain Stimulation

Deep brain stimulation is an emerging neurosurgical technique developed in Europe, and was first used in the United States in 1997 by Mayo Clinic surgeons in Jacksonville, Fla. The U.S. Food and Drug Administration approved DBS for use in treating a movement disorder known as essential tremor in 1997, and for Parkinson's disease in 2002. Since then, application of deep brain stimulation has been cautiously expanded to other disorders. Cluster headache is among the newest of these disorders that appear to respond to deep brain stimulation.

In deep brain stimulation surgery, Mayo Clinic surgeons implant an electrode in the hypothalamus, which, among other things, helps control sleep-wake cycles and the body's biological clock. Surgeons connect the electrode by wires threaded under the skin to a small pacemaker-like electrical stimulator implanted under the skin, just below the collarbone. The pacemaker transmits electrical pulses through the wire leads to the stimulating electrode in the brain. The pulses correct irregular electrical activity related to the headaches.

About Cluster Headache

Cluster headache is a rare condition considered to be the most intensely painful primary headache syndrome. They tend to occur in cycles or clusters that may be weeks or months long, and then disappear for a period of remission. They recur as another cluster attack, and the cycle continues. Each person's cluster cycle is different, but about 10 percent of people who have cluster headache have a chronic form with no periods of remission. Only one side of the head is affected, around the eye and temple area. Beyond excruciating pain, other symptoms include tearing up in the eyes, stuffy nose or drooping eyelid. Currently, only patients with the chronic form of cluster headache are being considered for DBS.

Collaboration and Support

The Mayo Clinic team also included neurologist J.D. Bartleson, M.D., Susan M. Torgrimson, and neurosurgeon Dudley Davis, M.D.

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