Symptoms and pathophysiology of cluster headache. Approach to combined occipital and supraorbital neurostimulation.

Cluster headache (CH) is included under section 3 - Trigeminal autonomic cephalalgias (TAC) of the International Headache Society (IHS) classification. It is one of the most frequent, painful and disabling primary headaches. Acute and preventive pharmacological treatments are often poorly tolerated and of limited effectiveness. Due to improved understanding of the pathophysiology of CH, neuromodulation devices are now considered safe and effective options for preventive and acute treatment of CH. In this paper, we review the information available to date, and present the case of a patient with disabling cluster headache highly resistant to medical treatment who underwent implantation of a peripheral nerve neurostimulation system to stimulate the supraorbital nerves (SON) and greater occipital nerve (GON) in our Pain Unit. We also review the diagnostic criteria for CH, the state of the knowledge on the pathophysiology of CH, and the role played by neuromodulation in treating this condition.

Clínica y fisiopatología de la cefalea en racimos. Acercamiento a la indicación de neuroestimulación combinada occipital y supraorbitaria / Symptoms and pathophysiology of cluster headache. Approach to combined occipital and supraorbital neurostimulation

La cefalea en racimos (CR) se encuadra dentro del apartado 3 de la clasificación de la Sociedad Internacional de Cefaleas (IHS), que es el reservado para las llamadas cefaleas trigémino autonómicas (CTA). Se trata de uno de los procesos de cefalea primaria más frecuentes, dolorosos e incapacitantes. Los tratamientos farmacológicos agudos y preventivos son, en muchos casos, mal tolerados y de efectividad limitada. Debido a la mejora en la comprensión de su fisiopatología de la CR, los dispositivos de neuromodulación se han posicionado como opciones seguras y eficaces de tratamiento preventivo y el tratamiento agudo de la CR. Haremos un recorrido sobre la información disponible hasta el momento y además, exponemos el caso de un paciente con CR incapacitante, muy resistente al tratamiento médico, tratado en nuestra Unidad del Dolor con el implante de un sistema de neuroestimulación de nervio periférico de nervios supraorbitario (SON) y nervio occipital mayor (GON). A continuación revisaremos los criterios diagnósticos que la definen la CR, lo datos que conocemos, a día de hoy, sobre su fisiopatología y la posición que ocupa actualmente la neuromodulación en el abordaje terapéutico de la misma. Con la descripción del caso clínico de un paciente tratado en nuestra Unidad del Dolor con una cefalea especialmente severa y resistente al tratamiento farmacológico.(AU)

Cluster headache (CH) is included under section 3 - Trigeminal autonomic cephalalgias (TAC) of the International Headache Society (IHS) classification. It is one of the most frequent, painful and disabling primary headaches. Acute and preventive pharmacological treatments are often poorly tolerated and of limited effectiveness. Due to improved understanding of the pathophysiology of CH, neuromodulation devices are now considered safe and effective options for preventive and acute treatment of CH. In this paper, we review the information available to date, and present the case of a patient with disabling cluster headache highly resistant to medical treatment who underwent implantation of a peripheral nerve neurostimulation system to stimulate the supraorbital nerves (SON) and greater occipital nerve (GON) in our Pain Unit. We also review the diagnostic criteria for CH, the state of the knowledge on the pathophysiology of CH, and the role played by neuromodulation in treating this condition.(AU)