Neuromodulation in the treatment of cluster headache
Isagulyan E.D.¹, Osipova V.V.^2.3, Ekusheva E.V.⁴, Sergeev A.V. ², Artemenko А.V.<sup>2

1</sup> National Medical Research Center of Neurosurgery named after acad. N.N. Burdenko, Moscow
² First Moscow State Medical University named after I.M. Sechenov
³ Scientific Neuropsychiatric Center named after Z.P. Solovyov, Moscow
⁴ Advanced Training Institute of the Federal Medical Biological Agency, Moscow

Cluster headache is one of the most frequent trigeminal vegetative cephalalgia, this type of primary headache is one of the most painful, associated with an increase in the number of suicidal attempts and, in general, negatively affects the quality of life of patients. Despite the large number of existing schemes of pharmacotherapy, cluster headache is refractory to conservative treatment in almost a third of cases, which predetermines the development of surgical methods of treatment, especially methods of neurostimulation. In clinical practice, three methods of neurostimulation are used: occipital nerves stimulation (ONS), sphenopalatine ganglion stimulation (SPGS), deep brain stimulation (DBS). When choosing a method, the principle "from simple to complex" is observed, beginning with the use of stimulation of peripheral structures (ONS and SPGS) and, in case of their inefficiency, DBS. Great attention should be paid to the selection of patients. An important factor in the appointment of neurostimulation is the reduction in the latency period, it is necessary to send the patient with a diagnosed incurable pain syndrome to the neurosurgeon as soon as possible for a consultation on the possible choice of treatment, since the duration of refractory pain is associated with a reduction in the potential effect of the stimulant.

Key words: cluster headache, neurostimulation, occipital nerves stimulation, sphenopalatine ganglion stimulation, deep brain stimulation 
For citation: Isagulyan E.D., Osipova V.V., Ekusheva E.V. et al. Neuromodulation in the treatment of cluster headache // RMJ. 2017. № 24. P. 1779–1784.