Rigmor Jensen, Mads Barløse, Lars Bendtsen, Nunu Lund, Anja Petersen.
Cluster headache is one of the most severe and disabling type of headaches. The pathophysiology of this disorder is largely unknown and it may be very difficult to treat, in particular the chronic form of cluster headache. There is a peculiar but yet unclarified relation between cluster headache and sleep as most of these severe headache attacks occur during the night, believed to be caused by a hypothalamic disturbance in the chronobiology.
Extensive sleep analysis in cluster headache patients as an inpatient study during the active bouts of cluster headache has been finalized and results indicate that cluster headache has a clear diurnal and circannual pattern but are not linked to specific sleep stages. We are continuing a large scale survey on the eventual relation between sleep and cluster headache based on questionnaires. Neurostimulation has been used in selected cases of chronic neuropathic pain and evidence is now accumulating for their use in headache disorders. As chronic cluster headache is one of the most disabling pain disorders known by mankind there is a constant search for new and better strategies, especially for those patients that are refractive to medical treatment strategies.
Since 2011 the Danish Headache Center has participated in an international multicentre study of the effect of neurostimulation of the sphenopalatine ganglion in patients with cluster headache, and we have now demonstrated a successful outcome in two-thirds of severely affected patients, and also with a long-lasting effect in 61% after 2 years observation. The significant cost-savings of medication lead to a general approval of this new promising treatment for cluster headache. We have continued to offer this treatment strategy to selected patients in an open labelled register study and in total 62 cluster patients are implanted now in Denmark.
Further neuromodulation studies on other strategies are also emerging and DHC is now one of the leading centres for neuromodulation in Europe. DHC is also chairing a new European multicentre study of the effect of SPG stimulation in disabling migraine and results are promising.
Søren Hillerup, professor, DDS, and Jørgen Rostgaard, CMT surgeon, DDS, Department of Oromaxillofacial Surgery, National Hospital, Copenhagen, Denmark. Anthony Carparso, Principal Clinical Scientist, Autonomic Technologies, Inc., CA, USA, Poul Jennum, Danish Center for Sleep Medicine, Glostrup Hospital, ElectroCore LLC, 51 Gibraltar Drive, Suite 3C, Morris Plains, NJ, USA.