Current surgical methods are only used amongst sufferers who have tried all of the available preventative and abortive treatments and hence are a last resort measure amongst carefully selected sufferers.
The present surgical options for CH are ONSI - occipital nerve stimulator implant; and DBS - deep brain stimulation.
The first option, ONSI is minimally invasive and involves implantation of a battery pack in either the shoulder area or the abdomen with wires tunnelled through the body, under the collar bone to the back of the skull, and positioning leads on the two occipital nerves at a point where the nerves exit the skull but are under the skin. A hospital stay of about four days is needed. The battery pack emits a pulse which helps stop the pain and also reduces the intensity and incidence of attacks. At first a battery is implanted which last for approximately three years. If the patient has a successful response, then at the end of that time a rechargeable battery is implanted and the patient recharges by wearing a belt with electronic connections to charge the internal battery. The patient can control the intensity of the stimulation with a remote-control device.
Some sufferers have also had successful results with DBS, which is much more invasive than ONSI and involves implantation of a battery, but this time the leads are placed on the posterior hypothalamus which sits underneath the brain and therefore the surgery is much more complex.
Also being trialled at the moment is a tiny device implanted in the cheek which stimulates the spheno-palatine ganglion [SPG]. The patient uses a hand-held device to trigger the stimulation.