Deep brain stimulation reduces number of medically intractable headache attacks

A new Mayo Clinic study has confirmed that ipsilateral hypothalamic Deep Brain Stimulation (DBS) may be an option for patients with a difficult form of medically intractable headache attacks.

The condition is known as SUNCT, or more formally, Short lasting, Unilateral, Neuralgiform headache attacks with Conjunctival injection and Tearing. Findings of the study were presented at the American Academy of Neurology Annual Meeting in Chicago on April 15 by Virgilio Gerald H. Evidente, M.D. and David Dodick, M.D., of the Department of Neurology, and Mark K. Lyons, M.D., of the Neurosurgery Department of Mayo Clinic in Arizona.

In SUNCT, functional magnetic resonance imaging (fMRI) may show increased blood flow in the ipsilateral posterior-inferior hypothalamus, and the current Mayo Clinic study follows the earlier report of an Italian patient who was successfully treated in 2005 with hypothalamic DBS for SUNCT.

Mayo Clinic physicians are now reporting on the first North American patient who ultimately underwent right hypothalamic Deep Brain Stimulation (DBS) surgery at Mayo Clinic with an implant of a DBS electrode. The month prior to surgery, he had experienced more than 4,000 attacks in just that month alone.

The 44-year-old man, who experienced onset of SUNCT at age 14, may be representative of patients who could be helped by the surgery that has the potential to stem the number of daily headaches.

The patient had reported he would typically have more than 200 excruciating, right-sided periorbital/temporal headaches daily, each lasting 60-90 seconds. His headaches, resembling cluster headaches, were not relieved by medication and were severe enough that he was rendered incapacitated over the last nine years.

The first month post-DBS, he only had an average of 45 attacks a day, and as little as four on some days. At nine months following the surgery, he averaged about 33 per day, and at one year, about 25 attacks per day.

"Our study conclusions indicate that ipsilateral hypothalamic DBS may be a viable option for patients with medically intractable SUNCT," says Dr. Evidente. "It may result in significant reduction in frequency of headaches, though it does not eliminate them."

(Source: Mayo Clinic: April 2008)