Department of Neurosurgery, Stanford University, Stanford, CA, USA.
Department of Neurology, Stanford University, Stanford, CA, USA.
Neuromodulation. 2019 Jun;22(4):388-397. doi: 10.1111/ner.12869. Epub 2018 Oct 10.
Cluster headaches are a set of episodic and chronic pain syndromes that are sources of significant morbidity for patients. The standard of care for cluster headaches remains medication therapy, however a minority of patients will remain refractory to treatment despite changes to dosage and therapeutic combinations. In these patients, functional neuromodulation using Deep Brain Stimulation (DBS) presents the opportunity to alleviate the significant pain that is experienced by targeting the neurophysiological substrates that mediate pain.
We review the literature on chronic cluster headache, including the growing number of DBS case reports and series that describe the alleviation of pain in a majority of patients through conventional or endoventricular targeting of the posterior hypothalamus and ventral tegmental area, with a minimal side effect profile.
In this review, the history and outcomes of DBS use for medication-refractory cluster headaches are examined, with discussion on future directions for improving this novel treatment modality and providing efficacious, longer-lasting pain relief in headache patients.
In patients with chronic cluster headache, functional neuromodulation using DBS presents the opportunity to alleviate the significant pain that is experienced by targeting the neurophysiological substrates that mediate pain.
丛集性头痛是一组发作性和慢性疼痛综合征，会给患者带来严重的发病。丛集性头痛的标准治疗仍然是药物治疗，但少数患者尽管改变了剂量和治疗组合，仍会对治疗产生抗药性。在这些患者中，使用深部脑刺激（DBS）进行功能性神经调节提供了通过靶向调节疼痛的神经生理底物来缓解疼痛的机会。
我们回顾了慢性丛集性头痛的文献，包括越来越多的 DBS 病例报告和系列报告，这些报告描述了通过对后下丘脑和腹侧被盖区的常规或心室内靶向治疗，大多数患者的疼痛得到缓解，副作用最小。
在这篇综述中，我们检查了 DBS 治疗药物难治性丛集性头痛的历史和结果，并讨论了改善这种新型治疗方式的未来方向，为头痛患者提供有效、持久的疼痛缓解。
在慢性丛集性头痛患者中，使用 DBS 进行功能性神经调节提供了缓解疼痛的机会，其靶点是调节疼痛的神经生理底物。
