Gamma Knife radiosurgery for the treatment of cluster headache: a systematic review

Franzini, Andrea; Clerici, Elena; Navarria, Pierina; Picozzi, Piero

doi:10.1007/s10143-021-01725-9

Cited by 7 publications

(5 citation statements)

References 21 publications

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Section: Neurostimulation For the Preventive Treatment Of Chronic Clu...mentioning

confidence: 99%

“…A systematic review from 5 open studies and 48 patients reported a meaningful pain reduction in 77%. 60 Noninvasive vagus nerve stimulation was examined as adjunctive prophylactic treatment of chronic cluster headache in the PREVA trial. 51 PREVA was a prospective, open-label, randomized study thatcomparedadjunctiveprophylacticnoninvasivevagusnervestimulation(n = 48)withstandardofcarealone(n = 49).Duringtherandomization phase, patients treated with standard of care plus noninvasive vagusnervestimulationhadasignificantlygreaterreductioninthenumber of attacks per week vs controls (−5.9 vs −2.1) for a mean therapeutic gain of 3.9 fewer attacks per week (95% CI, 0.5-7.2; P = .02).…”

Section: Neurostimulation For the Preventive Treatment Of Chronic Clu...mentioning

confidence: 99%

“…Another treatment option is gamma knife radiosurgery of the trigeminal nerve or the sphenopalatine ganglion. A systematic review from 5 open studies and 48 patients reported a meaningful pain reduction in 77% …”

Section: Management Of Chronic Cluster Headachementioning

confidence: 99%

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Management of Trigeminal Autonomic Cephalalgias Including Chronic Cluster

2023

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ImportanceTrigeminal autonomic cephalalgias (TACs) comprise a unique collection of primary headache disorders characterized by moderate or severe unilateral pain, localized in in the area of distribution of the first branch of the trigeminal nerve, accompanied by cranial autonomic symptoms and signs. Most TACs are rare diseases, which hampers the possibility of performing randomized clinical trials and large studies. Therefore, knowledge of treatment efficacy must be based only on observational studies, rare disease registries, and case reports, where real-world data and evidence play an important role in health care decisions.ObservationsChronic cluster headache is the most common of these disorders, and the literature offers some evidence from randomized clinical trials to support the use of pharmacologic and neurostimulation treatments. Galcanezumab, a monoclonal antibody targeting the calcitonin gene-related peptide, was not effective at 3 months in a randomized clinical trial but showed efficacy at 12 months in a large case series. For the other TACs (ie, paroxysmal hemicrania, hemicrania continua, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing, and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms), only case reports and case series are available to guide physicians in everyday management.Conclusions and RelevanceThe accumulation of epidemiologic, pathophysiologic, natural history knowledge, and data from case series and small controlled trials, especially over the past 20 years from investigators around the world, has added to the previously limited evidence and has helped advance and inform the treatment approach to rare TACs, which can be extremely challenging for clinicians.

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Section: Neurostimulation For the Preventive Treatment Of Chronic Clu...mentioning

confidence: 99%

Section: Neurostimulation For the Preventive Treatment Of Chronic Clu...mentioning

confidence: 99%

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Management of Trigeminal Autonomic Cephalalgias Including Chronic Cluster

2023

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“…As the FU assessment times were short in some of the previously reported cases, longer evaluation periods may have revealed more frequent occurrence of facial sensory disturbances. As a matter of fact, longterm studies of radiosurgical lesion of the trigeminal nerve and the SPG for cluster headache reported a considerable rate of trigeminal sensory disturbances and in some cases deafferentation pain [12,13]. Our findings suggest that trigeminal sensory dysfunction may occur after combined radiosurgical lesion of the trigeminal nerve and SPG in patients with SUNCT, although deafferentation pain or bothersome disturbances are not likely.…”

Section: Outcomes Of Radiosurgery For Sunctmentioning

confidence: 58%

Gamma Knife Radiosurgery for SUNCT: A Case Series

Franzini

Milani

Attuati

et al. 2023

Stereotact Funct Neurosurg

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Background: The treatment of medically refractory patients with chronic short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is challenging. Stereotactic radiosurgery targeting the trigeminal nerve and sphenopalatine ganglion (SPG) has been used as a less-invasive treatment. The outcomes of this procedure have been described in a few case reports. Objectives: The objective of the study was to report on the effect of Gamma Knife radiosurgery (GKRS) in 5 patients with chronic SUNCT. Methods: Retrospective review of our GKRS database identified 5 patients with chronic SUNCT who underwent GKRS targeted to the trigeminal nerve and SPG. A maximum dose of 80–85 Gy and 80 Gy was, respectively, delivered to the trigeminal nerve and SPG. Pain intensity and facial numbness were evaluated using the Barrow Neurological Institute (BNI) scores. Results: These 5 patients were clinically followed for a mean period of 26.2 months. Within a period ranging from 2 days to 9 months, GKRS was successful in reducing pain attacks and autonomic symptoms in all 5 patients. At the last assessments, BNI pain scores of I, II, and IIIa were achieved in 1, 1, and 3 patients, respectively. Two patients developed nonbothersome facial numbness (BNI facial numbness score II). Conclusions: These 5 cases show that GKRS targeted to both the trigeminal nerve and the SPG is effective in reducing pain and autonomic symptoms of patients with SUNCT, although nonbothersome trigeminal sensory disturbances may occur.

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“…The management and treatment of headache disorders is mostly pharmacological, although other therapeutic approaches include behavioural, invasive and non-invasive neuromodulation, and nutraceuticals [8,13,[62][63][64][65][66]. In all cases management should follow local guidelines that take due account of resources, but which guarantee access to all to appropriate care on an equitable basis, and to drugs on national essential medicines lists when needed.…”

Section: Medicines Diagnostics and Other Health Productsmentioning

confidence: 99%

The World Health Organization Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders and the headache revolution: from headache burden to a global action plan for headache disorders

Leonardi,

Martelletti,

Burstein

et al. 2024

J Headache Pain

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The World Health Organization (WHO) Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders was developed by WHO to address the worldwide challenges and gaps in provision of care and services for people with epilepsy and other neurological disorders and to ensure a comprehensive, coordinated response across sectors to the burden of neurologic diseases and to promote brain health across life-course. Headache disorders constitute the second most burdensome of all neurological diseases after stroke, but the first if young and midlife adults are taken into account. Despite the availability of a range of treatments, disability associated with headache disorders, and with migraine, remains very high. In addition, there are inequalities between high-income and low and middle income countries in access to medical care. In line with several brain health initiatives following the WHOiGAP resolution, herein we tailor the main pillars of the action plan to headache disorders: (1) raising policy prioritization and strengthen governance; (2) providing effective, timely and responsive diagnosis, treatment and care; (3) implementing strategies for promotion and prevention; (4) fostering research and innovation and strengthen information systems. Specific targets for future policy actions are proposed. The Global Action Plan triggered a revolution in neurology, not only by increasing public awareness of brain disorders and brain health but also by boosting the number of neurologists in training, raising research funding and making neurology a public health priority for policy makers. Reducing the burden of headache disorders will not only improve the quality of life and wellbeing of people with headache but also reduce the burden of neurological disorders increasing global brain health and, thus, global population health.

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Gamma Knife radiosurgery for the treatment of cluster headache: a systematic review

Cited by 7 publications

References 21 publications

Management of Trigeminal Autonomic Cephalalgias Including Chronic Cluster

Management of Trigeminal Autonomic Cephalalgias Including Chronic Cluster

Gamma Knife Radiosurgery for SUNCT: A Case Series

The World Health Organization Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders and the headache revolution: from headache burden to a global action plan for headache disorders

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