Headaches: Cluster - Resources

Surgery

In rare cases, surgical intervention may be considered for patients with chronic cluster headaches that do not respond to other treatments. Patients whose headaches have not gone into remission for at least a year may also be candidates for surgery. Most surgical approaches for cluster headache are still considered experimental, having been tested only on a relatively small number of patients. Surgery has shown limited success and can have distressing side effects. However, some surgical techniques, such as deep brain electrical stimulation, are showing promise.

Deep Brain Electrical Stimulation

---

---

Deep brain stimulation (also called neurostimulation) may relieve chronic cluster headaches in some patients who do not respond to drug therapy. A similar technique is approved for treating the tremors associated with Parkinson's disease. The surgeon implants a tiny wire in a specific part of the hypothalamus. The wire receives electrical pulses from a small generator implanted under the collarbone.

Although only a small number of patients have been treated, results to date are promising. Some patients have remained completely free of pain for an average of more than 7 months when the electrode is switched on. When the device is turned off, headaches reappear within days to weeks. The procedure is reversible and appears to be generally safe, although a few cases of fatal cerebral hemorrhage have occurred.

Occipital Nerve Stimulation

Occipital nerve stimulation is being investigated as a less invasive and less risky alternative to deep brain hypothalamus stimulation. Recent studies have reported promising results in a small group of patients with cluster headaches. Some patients became pain-free, while others had reduced frequency of headache attacks.

Vagus Nerve Stimulation

The vagus nerve runs between the brain and the abdomen. Vagus nerve stimulation (VNS) is a surgical procedure in which a small generator is placed under the skin on the left side of the chest. A surgeon makes a second incision in the neck and connects a wire from the generator to the vagus nerve. A doctor programs the generator to send mild electrical pulses at regular intervals. These pulses stimulate the vagus nerve.

VNS is sometimes used to treat epilepsy and depression that does not respond to drugs. It is also being investigated as a possible treatment for chronic migraine and cluster headaches.