GAMMA-KNIFE TREATMENT OF REFRACTORY CLUSTER HEADACHE

Four men and two women were treated for refractory cluster headache by gamma knife radiosurgery of the trigeminal nerve root entry zone. The maximum dose of radiation was 70 Gy to the isocenter. Of five patient s treated who had refractory chronic cluster headache and one with ref ractory episodic cluster headache, four had relief judged excellent. O f the two remaining patients with refractory chronic cluster headache, one had relief judged good and the other fair. Five of the six patien ts treated had relief within a few days to a week following gamma knif e radiosurgery. Three with chronic cluster headache had remissions all owing cessation of all preventive and abortive medication. Although on e patient experienced complete relief of chronic cluster headache, he continued to have migraine requiring medication. None of the patients treated developed significant postradiation side effects during a foll ow-up period of 8 to 14 months. The authors conclude that gamma knife radiosurgery of the trigeminal nerve affords great promise in the mana gement of chronic and refractory cluster headache. The technique seemi ngly carries negligible short- and long-term risk.