The Journal of Headache and Pain

Official Journal of the "European Headache Federation" and of "Lifting The Burden - The Global Campaign against Headache"

The Journal of Headache and Pain Cover Image

Volume 15 Supplement 1

Abstracts from the 4th European Headache and Migraine Trust International Congress: EHMTIC 2014

Open Access

EHMTI-0279. Deep brain stimulation for refractory chronic cluster headache

  • S Miller1,
  • H Akram2,
  • S Lagrata1,
  • M Hariz2,
  • M Matharu1 and
  • L Zrinzo2
The Journal of Headache and Pain201415(Suppl 1):C44

Published: 18 September 2014


Deep Brain StimulationNerve PalsyMedian ChangeRecurrent EpisodeVisual Analogue Score


Chronic cluster headache (CCH) is an excruciating, unilateral headache with recurrent episodes of severe pain associated with ipsilateral autonomic features. 10-20% of patients are refractory to medical management. We present a prospective cohort of 19 patients with intractable CCH treated with posterior hypothalamic deep brain stimulation (DBS).


Patients with refractory CCH referred to multidisciplinary headache clinic at our centre underwent DBS. Clinical data was collected pre and post-treatment. Headache load (HAL) (defined as [severity (on the visual analogue score)] x [duration] x [frequency] of headaches over a 2 week period) was calculated before and after treatment. A treatment response was identified as a 30% or more reduction in HAL.


19 patients (M=15) with a median age of 48 years (33-67 years) underwent surgery. Median follow up time was 12 months (9-48 months). 17 patients had at least one year follow up. Five patients failed to respond to treatment but nine showed a reduction in HAL of more than 80%. Within three months of surgery, the median change in HAL was 62% (0-100%) and at twelve months was 69% (0-100%). Significant differences exist between HAL at baseline and at three (p=0.001) and twelve months (p=0.06). There were no serious adverse events. One patient reported persistent diplopia, which was due to decompensation of a long-standing third nerve palsy.


Posterior Hypothalamic DBS appears a safe and effective treatment for CCH and should be considered for suitable patients who fail conventional treatment.

No conflict of interest.

Authors’ Affiliations

Headache, UCL Institute of Neurology, London, UK
Functional Neurosurgery, UCL Institute of Neurology, London, UK


© Miller et al; licensee Springer. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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