Objective To present long term outcomes of ventral tegmental area (VTA) deep brain stimulation (DBS) for medically refractory chronic cluster headache (CCH) and short-lasting unilateral neuralgiform headache attacks (SUNHA) Methods Open label study using prospectively collected clinical data in consecutive patients treated by VTA DBS between 2009 and 2019 in a single tertiary neuroscience centre, treated by a multidisciplinary team. Results Between 2009 and 2019, 71 patients (43 CCH and 28 SUNHA) were treated with VTA DBS. Mean duration of follow up was 5.6 years (range 1.0-11.7 years). Overall, there was a significant improvement in attack frequency, attack severity, and attack duration in both groups (all p<0.001). Twenty nine (67.4%) CCH patients and 20 (71.4%) SUNHA patients were classed as responders (a greater than 50% improvement in attack frequency). Adverse events were rare Four non-responders had the DBS system explanted, two of them secondary to infection and one due to post-surgical neuropathic pain around the head wound site. Four patients died from unrelated conditions during the study period. Conclusions This study provides open label evidence than VTA DBS is a safe and effective treatment for refractory CCH and SUNHA, an effect which is maintained at long term follow up.