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Surgical Interventions for Cluster Headache, Including Implanted Stimulators

  • Koen Paemeleire
  • Paolo Martelletti
Reference work entry

Abstract

Refractory cluster headache (rCH) is one of the most devastating conditions known to man. Historically, only destructive procedures were available for these desperate patients in which all drug therapies failed. The surgical interventions were aimed at the sensory trigeminal nerve, including the trigeminal sensory root, Gasserian ganglion, and supra- or infraorbital nerves; or the autonomic pathways involved in cluster headache (CH), including the nervus intermedius, nervus petrosus major, and sphenopalatine ganglion. Especially, trigeminal destructive procedures are associated with potential serious long-term consequences such as anesthesia dolorosa, as well as corneal anesthesia and ulceration. The surgical management of rCH is changing drastically with the advent of neuromodulatory techniques, such as occipital nerve stimulation and hypothalamic deep brain stimulation. These techniques were developed based on the physiology of the trigeminocervical complex and on evidence for a hypothalamic generator in CH, respectively. The potential therapeutic effect of each technique should be carefully balanced against known potential long-term consequences, knowing that long-term data on the rate of recurrence of CH after a procedure are generally lacking. No conclusive recommendations can be formulated at present, but we will suggest some guidelines toward implementing surgical interventions for rCH in clinical practice. We will briefly touch upon greater occipital nerve block as a transitional treatment.

Keywords

Deep Brain Stimulation Cluster Headache Chronic Cluster Headache Cluster Headache Patient Great Occipital Nerve 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Lifting The Burden 2011

Authors and Affiliations

  1. 1.Department of NeurologyGhent University HospitalGhentBelgium
  2. 2.Department of Medical and Molecular Sciences, School of Health SciencesSchool of Health Sciences, Sapienza University of RomeRomeItaly

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