title: Deep brain stimulation in headache.
abstract: BACKGROUND
  Deep brain stimulation of the posterior hypothalamic area was first introduced in 2000 to treat drug-refractory chronic cluster headache (CH).
  
  
  RESULTS
  So far, hypothalamic stimulation has been employed in 79 patients suffering from various forms of intractable short-lasting unilateral headache forms, mainly trigeminal autonomic cephalalgias. The majority were (88.6%) chronic CH, including one patient who suffered from symptomatic chronic CH-like attacks; the remaining were short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), one had paroxysmal hemicranias and one symptomatic trigeminal neuralgia. Overall, after a mean follow up of 2.2 years, 69.6% (55) hypothalamic-stimulated patients showed a ≥50% improvement.
  
  
  CONCLUSIONS
  These observations need confirmation in randomised, controlled trials. A key role of the posterior hypothalamic area in the pathophysiology of unilateral short-lasting headaches, possibly by regulating the duration rather than triggering the attacks, can be hypothesised. Because of its invasiveness, hypothalamic stimulation can be proposed only after other, less-invasive, neurostimulation procedures have been tried.
authors.affiliation: Department of Neurology, Headache and Neurology Department and Pain Neuromodulation Unit, Fondazione Istituto Nazionale Neurologico Carlo Besta, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Leone
authors.affiliation: Department of Neurology, Headache and Neurology Department and Pain Neuromodulation Unit, Fondazione Istituto Nazionale Neurologico Carlo Besta, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Proietti Cecchini
mesh_terms: D046690:Deep Brain Stimulation / Q000379:methods*; D019317:Evidence-Based Medicine; D006261:Headache / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D007031:Hypothalamus; D016896:Treatment Outcome
keywords: Deep brain stimulation; SUNCT; cluster headache; drug resistant; hypothalamic stimulation; intractable; neurostimulation; paroxysmal hemicrania; trigeminal autonomic cephalalgias; trigeminal neuralgia