We provide a detailed case history of the first patient to receive bilateral h ypothalamic stimulation to control severe bilateral chronic intractable cluster headaches initially occurring mostly on the left. These attacks were accompanied by life threaten ing hypertensive crises and a grave deterioration in the pat ients psychological state. Destructive surgery to the left trigeminal was abso lutely contraindicated. Electrode implantation and continuous stimulation of the left posterior inferior hypothalamus resolved the left attacks. After four dest ructive operations on the right trigeminal, right side attacks recurred. Electro de implantation (with continuous stimulation) to the right resulted in immediate resolution of the right side pain and the hypertensive crises. On several occas ions, both known and unknown to the patient, the stimulators were turned off: in all cases, crises reappeared and in all instances disappeared relatively quickl y after turning stimulation back on. Pain crises have never reappeared when ipsi lateral stimulation is ongoing. The only side effects were observed during long term bilateral stimulation, consisting of transient vertigo and bradycardia. A fter 42 months (left) and 31 months (right) of follow up, the patient remains c risis free without the need for pharmacological prophylaxis. We provide a detailed case history of the first patient to receive bilateral h ypothalamic stimulation to control severe bilateral chronic infection of hypertension Destructive surgery to the left trigeminal was abso lutely contraindicated. Electrode implantation and continuous stimulation of the left posterior inferior hypothalamus resolved the left attacks. After four dest ructive operations on the right trigeminal, right side attacks recurred. Electro implantation with continuous stimulation) to the right resulted in immediate resolution of the right side pain and the hypertensive crises. both several known and unknown to the patient, the stimulators were turned off: in all cases, crises reappeared and in all instances disappeared relatively quickl y after turning stimulation back on. Pain flies have never reappeared when ipsi lateral stimulation is ongoing. The only side effects were observed during long term bilateral stimulation, consisting of transient vertigo and bradycardia. A fter 42 months (left) and 31 months (right) of follow up, the patient remains c risis free without the need for pharmacological prophylaxis.