High Cervical Epidural Neurostimulation for Cluster Headache: Case Report and Review of The Literature

Cluster headache belongs to the trigeminal autonomic cephalgias. Clinically, it is characterized by attacks of severe pain localized orbitally, supraorbitally or temporally, lasting for 15–180 min and occuring from once every other day to eight times a day. The attacks are associated with one or more of the following: conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating, miosis, ptosis and eyelid oedema (1). Attacks occur in series (so-called cluster periods or bouts) that are usually separated by remission periods lasting for months or years. In chronic cluster headache (CCH) substantial remission periods are lacking. Mean age at onset is 20–40 years and, for unknown reasons, 80% of patients are male. Treatment usually consists of drug therapy. Agents used for acute therapy are inhalation of high-flow oxygen, sumatriptan subcutaneous injection or nasal spray and zolmitriptan nasal spray. For transitional or short-term prophylaxis, corticosteroids and ergotamine derivatives are used. The cornerstone of maintenance prophylaxis is verapamil, but lithium and methysergide may also be used. Some patients respond to melatonin or topiramate (2). Nevertheless, there are a significant percentage of patients with CCH that do not experience satisfactory pain relief with drug therapy alone. In the last years new invasive techniques have emerged, and operational criteria have been proposed to define pharmacologically intractable headache (3). Case report