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Patients saw significant improvements in help-seeking behaviors and reductions in anxiety that positively correlated with headache load.
Davide Cappon, PhD
Deep brain stimulation in the ventral tegmental area (VTA-DBS) for the treatment of chronic, refractory cluster headache has no apparent ill-effect on tests of cognitive function, according to study results published in Cephalalgia.1
While VTA-DBS has shown significant clinical benefit for reducing frequency and severity of medically refractory cluster headache,2 it was previously unknown how the treatment affects cognition, mood, pain experience and behavior, and quality of life.
To examine this, researchers led by Davide Cappon, PhD, of Harvard Medical School, enrolled 18 consecutive patients with refractory chronic cluster headache; patients had experienced medically refractory symptoms for ³24 months and had failed to respond to treatment with at least 5 of the following therapies: verapamil, lithium, methysergide, topiramate, melatonin, gabapentin, or valproate.
All patients underwent neuropsychological assessment prior to and after implantation (mean, 14±4.5 months) on tests of global cognition (Mini Mental State Examination), intelligence (Wechsler Abbreviated Scale of Intelligence), verbal memory (California Verbal Learning Test-II), executive function (Delis—Kaplan Executive Function System), attention (Paced Auditory Serial Addition Test), depression (Beck Depression Inventory and Hospital Anxiety and Depression Rating Scale-D), anxiety (Hospital Anxiety and Depression Rating Scale-A), apathy (Starkstein Apathy Scale), and hopelessness (Beck Hopelessness Scale), as well as subjective pain experience (McGill Pain Questionnaire), behavior (Pain Behavior Checklist), and quality of life (Short Form-36).
The researchers observed a 52% improvement in headache frequency, with the frequency of reported attacks going from 5 to 2 daily (P <.001) and 55% of participants reported at least a 40% reduction in the number of daily attacks following VTA-DBS. Scores on the Verbal Rating Scale for headache severity were also significantly reduced from 10 to 7 (P <.001), with 40% of patients reporting at least a 30% reduction. Headache load was also significantly reduced following VTA-DBS (P <.005).
There were no significant differences observed pre- and post-DBS in measures of global cognition and intelligence, as well as executive function and memory. However, the researchers noted a significant reduction in scores on the Pain-Behavior Checklist Help Seeking measure (M=4.00 vs M=2.61; P <.001), with 80% of participants showing improvement following VTA-DBS compared with no change (13%) or decline (6%). A significant reduction in anxiety was also recorded (P <.001), with 61% of patients reporting a reliable reduction in anxiety at follow-up. Participants also showed improvements in social functioning and emotional wellbeing, although these changes were not statistically significant.
Further analyses with Pearson correlation revealed a significant, positive correlation between anxiety levels and changes in headache load (P <.01).
“Results of the present study provide unique data that indicate that surgical implantation of electrodes and chronic stimulation of the VTA is generally safe from a cognitive perspective,” the authors wrote. “We found that VTA-DBS produced clinical benefits on CH frequency, severity and load … and was associated with significant decrease of anxiety and significant improvement of pain-related help- seeking behaviors, indicating better coping with pain after surgery.”
1. Cappon D, Ryterska A, Lagrata S, et al. Ventral tegmental area deep brain stimulation for chronic cluster headache: Effects on cognition, mood, pain report behaviour and quality of life. Cephalalgia. Published March 21, 2019. https://journals.sagepub.com/doi/full/10.1177/0333102419839957. Accessed March 22, 2019.
2. Akram H, Miller S, Lagrata S, et al. Ventral tegmental area deep brain stimulation for refractory chronic cluster headache. Neurology. 2016;86:1676—1682.