Long term outcomes of deep brain stimulation for treatment refractory chronic cluster headache and sunha

Objective To present long term outcomes of ventral tegmental area (VTA) deep brain stimulation (DBS) for medically refractory chronic cluster headache (CCH) and short-lasting unilateral neuralgiform headache attacks (SUNHA) Methods Open label study using prospectively collected clinical data in consecutive patients treated by VTA DBS between 2009 and 2019 in a single tertiary neuroscience centre, treated by a multidisciplinary team. Results Between 2009 and 2019, 71 patients (43 CCH and 28 SUNHA) were treated with VTA DBS. Mean duration of follow up was 5.6 years (range 1.0-11.7 years). Overall, there was a significant improvement in attack frequency, attack severity, and attack duration in both groups (all p<0.001). Twenty nine (67.4%) CCH patients and 20 (71.4%) SUNHA patients were classed as responders (a greater than 50% improvement in attack frequency). Adverse events were rare Four non-responders had the DBS system explanted, two of them secondary to infection and one due to post-surgical neuropathic pain around the head wound site. Four patients died from unrelated conditions during the study period. Conclusions This study provides open label evidence than VTA DBS is a safe and effective treatment for refractory CCH and SUNHA, an effect which is maintained at long term follow up.