title: Hypothalamic deep-brain stimulation modulates thermal sensitivity and pain thresholds in cluster headache.
abstract: Deep-brain stimulation (DBS) of the posterior hypothalamus has been shown to be clinically effective for drug-resistant chronic cluster headache, but the underlying mechanism is still not understood. The hypothalamus as an important centre of homeostasis is connected among others to the trigeminal system via the trigeminohypothalamic tract. We aimed to elucidate whether hypothalamic stimulation affects thermal sensation and pain perception only in the clinically affected region (the first trigeminal branch) or in other regions as well. Thus, we examined three groups: chronic cluster headache patients with unilateral DBS of the posterior hypothalamus (n = 11), chronic cluster headache patients without DBS (n = 15) and healthy controls (n = 29). Perception and pain thresholds for hot and cold stimuli were determined bilaterally in all subjects supraorbitally, at the forearm, and in the lower leg. In DBS patients, thresholds were determined with the stimulator activated and inactivated. Cold pain thresholds at the first trigeminal branch were increased on the stimulated side in the DBS group compared to healthy subjects (p = .015). The DBS group also had higher cold detection thresholds compared to non-implanted cluster headache patients (p < .05). Short-term interruption of stimulation did not induce any changes in DBS patients. Clinically relevant differences were found neither between non-stimulated cluster headache patients and healthy controls nor between the affected and the non-affected sides in the chronic cluster headache patients without DBS. These results support the notion that neurostimulation of the posterior hypothalamus is specific for cluster headache and only affects certain aspects of pain sensation.
authors.affiliation: Department of Systems Neuroscience, University of Hamburg, Germany. t.juergens@uke.de
authors.forename: Tim P
authors.initials: TP
authors.lastname: Jürgens
authors.forename: Massimo
authors.initials: M
authors.lastname: Leone
authors.forename: Alberto
authors.initials: A
authors.lastname: Proietti-Cecchini
authors.forename: Volker
authors.initials: V
authors.lastname: Busch
authors.forename: Eliana
authors.initials: E
authors.lastname: Mea
authors.forename: Gennaro
authors.initials: G
authors.lastname: Bussone
authors.forename: Arne
authors.initials: A
authors.lastname: May
mesh_terms: D000328:Adult; D000368:Aged; D003027:Cluster Headache / Q000523:psychology* / Q000628:therapy*; D003080:Cold Temperature; D046690:Deep Brain Stimulation; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006358:Hot Temperature; D006801:Humans; D007034:Hypothalamus, Posterior / Q000502:physiology*; D007206:Individuality; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017288:Pain Threshold / Q000502:physiology*; D011446:Prospective Studies; D013697:Thermosensing / Q000502:physiology*