Headache? Take 3 Volts and Call Me in the Morning

From the WebMD Archives

May 15, 2001 (Philadelphia) -- Talk about being wired: A 39-year-old man with severe, disabling cluster headaches that didn't respond to any available medications had his headaches completely disappear after surgeons implanted a slim wire into his brain and hooked it up to an electrical stimulator. The first-of-its kind procedure was reported by Italian surgeons here for the annual meeting of the American Academy of Neurology.

Since the surgery, "his life has completely changed; he was totally disabled and unable to work for five years," Massimo Leone, MD, tells WebMD.

Within 48 hours of receiving the wire -- and the three volts of electrical stimulation it carried to the brain region where the headaches occurred -- the man experienced complete relief. When the stimulator was turned off on two occasions when the patient required surgery on one of his eyes, the headaches returned within 24-48 hours, but were again relieved when the stimulator was switched back on.

The patient, a heavy equipment operator, has been free of headaches for nearly a year and has been able to return to work, says Leone says, who works in the department of neurology and neurosurgery at Carlo Besta National Neurological Institute in Milan, Italy.

Chris Janson, MD, from the department of neurosurgery at Thomas Jefferson University in Philadelphia, tells WebMD that similar operations are often deemed to be successful if the patient is able to significantly reduce his medications after the procedure.

"In this case it seems that you could wean somebody completely off his or her drugs, and at least in this one individual it works pretty well," says Janson, who was not involved in the Italian study.

Cluster headache is a rare but serious form of headache, so-called because it occurs in clusters or groups. "It is probably one of the worst types of pain that man can suffer from," Leone says.

Unlike migraines, which occur more frequently in women than in men, cluster headaches are a predominantly male affliction, by a factor of about 5:1.

Cluster headaches can occur in episodes of one or two a year, or in the case of the Italian man, they can recur frequently. Although some patients get relief from drugs such as those used to treat migraine, some people with this frequently recurring type require surgery to cut or destroy one of the nerves in the face. This isn't necessarily a cure, however, for these nerves can eventually regenerate.

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The Italian man's physicians had tried nearly all of these options, and all had failed, so the surgeons decided to try a different approach (with the patient's consent), called deep brain stimulation, which has been shown to be successful in some cases of Parkinson's disease and other movement disorders.

Recent brain imaging studies have shown that a certain area of the brain appears to be highly active during a cluster headache attack. The surgeons used a three-dimensional imaging technique to precisely place the wire into that region. The wire runs under the skin of the patient's scalp and is connected to a small electrical stimulator implanted under the collarbone.

The surgeons have since performed the procedure on two additional patients, with similar success, says Givonanni Broggi, MD, chairman of neurosurgery at the Carlo Besta Institute, in an interview with WebMD.

WebMD Health News Reviewed by Jacqueline Brooks, MBBCH, MRCPsych
© 2001 WebMD, Inc. All rights reserved.

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