12. Deep Brain Stimulation in Cluster Headache

  1. Sam Eljamel3 and
  2. Konstantin V. Slavin4
  1. Giovanni Broggi,
  2. Giuseppe Messina and
  3. Angelo Franzini

Published Online: 19 JUL 2013

DOI: 10.1002/9781118346396.ch12

Neurostimulation: Principles and Practice

Neurostimulation: Principles and Practice

How to Cite

Broggi, G., Messina, G. and Franzini, A. (2013) Deep Brain Stimulation in Cluster Headache, in Neurostimulation: Principles and Practice (eds S. Eljamel and K. V. Slavin), John Wiley & Sons, Ltd, Oxford, UK. doi: 10.1002/9781118346396.ch12

Editor Information

  1. 3

    Centre for Neurosciences, Ninewells Hospital & Medical School, Dundee, Scotland, UK

  2. 4

    Department of Neurosurgery, University of Illinois at Chicago. Chicago, Illinois, USA

Author Information

  1. Fondazione Instituto Neurologico “Carlo Besta”, Milan, Italy

Publication History

  1. Published Online: 19 JUL 2013
  2. Published Print: 19 AUG 2013

ISBN Information

Print ISBN: 9781118346358

Online ISBN: 9781118346396



  • chronic cluster headache (CCH);
  • deep brain stimulation (DBS);
  • neurostimulation;
  • posterior hypothalamus (pHyp)


Cluster headache is characterized by disabling, strictly unilateral painful attacks mostly perceived in the retro‐orbital area. Conventional conservative treatment of the chronic cluster headache (CCH) consists of prophylactic therapy and abortive therapy. Deep brain stimulation (DBS) of the posterior hypothalamus (pHyp) was the first application in which the choice of target was motivated by functional neuroimaging data. Initial guidelines for inclusion criteria for DBS of the pHyp in CCH were (i) the presence of diagnostic criteria for CCH according to the International Headache Society; (ii) inadequate relief from prophylactic therapy, including verapamil, lithium, sodium valproate, methysergide, topiramate, gabapentin, non‐steroidal anti‐inflammatory drugs such as indomethacin, and corticosteroids; and (iii) CCH lasting at least 2 years, with strictly lateralized pain attacks. This chapter hypothesizes that pHyp DBS acts through the remodeling of neural circuits and so it requires a certain amount of time conditioned by individual neural plasticity.