• Daivik B Vyas, Allen L Ho, David Y Dadey, Arjun V Pendharkar, Eric S Sussman, Robert Cowan, and Casey H Halpern.
• Department of Neurosurgery, Stanford University, Stanford, CA, USA.
• Neuromodulation. 2019 Jun 1; 22 (4): 388-397.

ObjectivesCluster headaches are a set of episodic and chronic pain syndromes that are sources of significant morbidity for patients. The standard of care for cluster headaches remains medication therapy, however a minority of patients will remain refractory to treatment despite changes to dosage and therapeutic combinations. In these patients, functional neuromodulation using Deep Brain Stimulation (DBS) presents the opportunity to alleviate the significant pain that is experienced by targeting the neurophysiological substrates that mediate pain.Material And MethodsWe review the literature on chronic cluster headache, including the growing number of DBS case reports and series that describe the alleviation of pain in a majority of patients through conventional or endoventricular targeting of the posterior hypothalamus and ventral tegmental area, with a minimal side effect profile.ResultsIn this review, the history and outcomes of DBS use for medication-refractory cluster headaches are examined, with discussion on future directions for improving this novel treatment modality and providing efficacious, longer-lasting pain relief in headache patients.ConclusionIn patients with chronic cluster headache, functional neuromodulation using DBS presents the opportunity to alleviate the significant pain that is experienced by targeting the neurophysiological substrates that mediate pain.© 2018 International Neuromodulation Society.

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