LONG-TERM RESULTS OF RADIOFREQUENCY RHIZOTOMY IN THE TREATMENT OF CLUSTER HEADACHE

Although the primary treatment of chronic cluster headache is medical, surgical treatment is sometimes used. The authors reviewed the charts of seven patients (ages 36 to 68 years) with chronic cluster headache to identify who responded best to percutaneous stereotactic radiofreq uency rhizotomy after medical treatment failed. All patients had immed iate pain relief after surgery. At follow-up (median 5 years, range 2 to 20 years), two patients remained pain-free 7 and 20 years later (ex cellent results); three patients had mild pain recurrence that was wel l controlled on medications (good results) 6 to 12 months after surger y; and two patients had major pain recurrence 4 days and 2 months afte r surgery (poor results). Six patients had relief of vasomotor symptom s. One patient had transient diplopia and keratitis without permanent sequelae. Both patients with excellent results had preoperative major pain around the eye; both patients with poor results had major pain ar ound the temple, ear, and cheek; and the three patients with good resu lts had pain equally severe in the eye, temple, and cheek. There was n o association between patient age or sex, pain duration, preoperative response to lidocaine blockade, or previous surgery with pain relief. No differences occurred in pain relief between patients with dense hyp algesia and patients with analgesia. The authors conclude that (1) som e patients with chronic cluster headache treated by percutaneous stere otactic radiofrequency rhizotomy achieve long-term pain relief, and (2 ) surgery on the trigeminovascular system alone may not cure the condi tion in patients with major pain around the temple, ear, and cheek.