Deep brain stimulation in the ventral tegmental area (VTA-DBS) may effectively reduce the frequency and intensity of refractory chronic cluster headache and alleviate anxiety associated with headaches, according to a study published in Cephalalgia.
A total of 18 consecutive patients with cluster headache who underwent VTA-DBS were included in the study. Patients were assessed prior to intervention and then at a mean follow-up of 14 months. Global cognition (Mini Mental State Examination), intelligence (Wechsler Abbreviated Scale of Intelligence), verbal memory (California Verbal Learning Test-II), executive function (Delis–Kaplan Executive Function System), and attention (Paced Auditory Serial Addition Test) were assessed. Changes in depression (Beck Depression Inventory and Hospital Anxiety and Depression Rating Scale-D), anxiety (Hospital Anxiety and Depression Rating Scale-A), apathy (Starkstein Apathy Scale), hopelessness (Beck Hopelessness Scale), subjective pain experience (McGill Pain Questionnaire), behavior (Pain Behavior Checklist), and quality of life (Short Form-36) were also evaluated.
Treatment with VTA-DBS was associated with significant improvement in headache frequency, which was reduced from a mean of 5 attacks per day prior to intervention to 2 attacks per day at follow-up (P <.001). VTA-DBS was also associated with reduction in headache severity from a mean score of 10 at baseline to 7 at the 14-month follow-up on the verbal rating scale (P <.001). Improvements in headache frequency and severity were associated with reductions in anxiety (mean Hospital Anxiety and Depression Rating Scale-A score: 11.94 at baseline, 8.00 at follow-up; P <.001), as well as improvements in help-seeking behaviors (mean Pain Behavior Checklist score: 4.00 at baseline; 2.61 at follow-up; P <.001). All other outcomes were not affected by VTA-DBS.
Study limitations include the small sample size.
“It is difficult to determine whether this beneficial effect on anxiety is generated by VTA stimulation directly altering the activity in the mesolimbic circuits, or indirectly because VTA-DBS reduced headache frequency and severity,” noted the study authors.
Cappon D, Ryterska A, Lagrata S, et al. Ventral tegmental area deep brain stimulation for chronic cluster headache: Effects on cognition, mood, pain report behaviour and quality of life [published online March 21, 2019]. Cephalalgia. doi:10.1177/0333102419839957