Deep Brain Stimulation for Chronic Cluster Headaches: A Systematic Review and Meta-Analysis

Abstract

<b><i>Background:</i></b> Chronic cluster headache (CCH) is a severe and debilitating sub-type of trigeminal autonomic cephalalgia that can be resistant to medical management and associated with significant impairment in quality of life. Studies of deep brain stimulation (DBS) for CCH have provided promising results but have not been assessed in a comprehensive systematic review/meta-analysis. <b><i>Objective:</i></b> The objective was to perform a systematic literature review and meta-analysis of patients with CCH treated with DBS to provide insight on safety and efficacy. <b><i>Methods:</i></b> A systematic review and meta-analysis were performed according to PRISMA 2020 guidelines. 16 studies were included in final analysis. A random-effects model was used to meta-analyze data. <b><i>Results:</i></b> Sixteen studies reported 108 cases for data extraction and analysis. DBS was feasible in &gt;99% of cases and was performed either awake or asleep. Meta-analysis revealed that the mean difference in headache attack frequency and headache intensity after DBS were statistically significant (<i>p</i> &lt; 0.0001). Utilization of microelectrode recording was associated with statistically significant improvement in headache intensity postoperatively (<i>p</i> = 0.006). The average overall follow-up period was 45.4 months and ranged from 1 to 144 months. Death occurred in &lt;1%. The rate of major complications was 16.67%. <b><i>Conclusions:</i></b> DBS for CCHs is a feasible surgical technique with a reasonable safety profile that can be successfully performed either awake or asleep. In carefully selected patients, approximately 70% of patients achieve excellent control of their headaches.