Feasibility of simultaneous vagal nerve and deep brain stimulation in chronic cluster headache: case report and considerations

In pathologies, such as refractory epilepsy, major depression and cluster headache, there could be indication to both vagal nerve stimulation (VNS) and deep brain stimulation (DBS). In particular, Mauskop (Cephalalgia 25:82–96, 2005) reported the efficacy and safety of VNS in chronic cluster headache. At our Institute, we perform posterior hypothalamic DBS for such clinical condition since 2000 and results appear to be encouraging. Here, we report the case of a patient with chronic cluster headache (CCH) who had initially improved after DBS, whose clinical effect subsequently diminished after head trauma; we performed VNS in the same patient, thus obtaining a new 50% reduction in frequency of pain bouts. Such benefit and the absence of any side effects (possibly due to the co-existence of the two systems) may suggest the possibility of a second therapeutical chance not only in CCH but also in the other two above-mentioned severely disabling pathological conditions.