ABSTRACT

INTRODUCTIONCluster headache (CH) is a primary headache disorder which is designated as a trigeminal autonomic cephalagia (TAC) by the International Headache Society classifications [1]. It is considered one of the most disabling of all headache types and has a population prevalence of one case per 500 people [2]. Fortunately most patients have an episodic form of the disorder and up to 27% of patients have only a single cluster event. However, according to the Headache Classification Committee of the IHS [1], 10-15% of patients with CH have chronic cluster headache without apparent remission between attacks. For those patients, the pain and disability associated with CH can be so severe that suicide is often contemplated [3].Neuromodulation in the form of deep brain stimulation (DBS) is one of the emerging therapeutic options to rescue

patients with chronic CH (CCH) who are refractory to standard treatments. The past 15 years have seen the investigational use of DBS for this select group of these patients, with approximately 50 published cases worldwide. This chapter reviews the characteristics of CH, conventional treatment of CH, and the patient selection, surgical approach, outcomes, and complications of DBS for CCH.