Current evidence points towards the posterior hypothalamic region as a locus of cluster headache (CH) generation. This has led to surgical targeting of the region using stereotactic deep brain stimulation (DBS) for relief in its most severe, intractable, chronic form. Though implicated in the pathogenesis of attacks, the precise nature of hypothalamic involvement remains unclear. DBS, besides offering therapeutic benefit to patients, provides a unique opportunity to observe local field activity within the vicinity of the target nucleus.
During surgical implantation of the DBS electrode for cluster head pain, one of our patients suffered a CH attack. Analysis of the data reveals a characteristic structure dissimilar to that observed in the headache-free state. To the authors’ knowledge this is the first recorded account of neuronal activity observed during a cluster attack, providing evidence for a specific neural rhythm associated with episodic onset. Our results both support and extend the current literature which has long implicated hypothalamic activation as key to CH generation, principally through indirect hemodynamic neuroimaging techniques. Our findings elucidate the role of the posterior hypothalamus in CH pathogenesis and provide the first empirical rationale for efficacious stimulator titration.
John-Stuart Brittain (UK)