From the Guidelines
Cluster headaches in children are characterized by severe, unilateral pain, typically around or behind one eye, accompanied by ipsilateral cranial autonomic symptoms, such as conjunctival injection, lacrimation, and nasal congestion, as noted in a 2021 study published in Nature Reviews Neurology 1.
Key Symptoms
- Severe, one-sided pain around or behind one eye
- Autonomic symptoms like tearing, redness of the eye, nasal congestion, and facial sweating on the affected side
- Restlessness during attacks, unlike migraine sufferers who prefer to lie still
- Headaches occur in cyclical patterns or clusters lasting weeks to months, followed by remission periods
- Each attack typically lasts 15-180 minutes and can occur multiple times daily, often at the same time each day, with nighttime attacks being common ### Diagnosis and Treatment Diagnosis is challenging in children as they may struggle to describe symptoms precisely, but it is crucial to distinguish cluster headaches from other primary and secondary headache disorders, such as migraine, tension-type headache, and medication-overuse headache, as discussed in the 2021 study 1. Treatment options include oxygen therapy, triptans (sumatriptan), preventive medications like verapamil, and corticosteroids for short-term prevention.
Recommendation
Children with suspected cluster headaches should see a pediatric neurologist promptly for proper diagnosis and treatment, as these headaches are extremely painful and disruptive to a child's quality of life, and early intervention can help manage symptoms and prevent significant distress, as implied by the discussion of differential diagnoses in the 2021 study 1.
From the Research
Cluster Headache Symptoms in Children
- Cluster headache is a rare cause of headache in children, with onset before 12 years of age being unusual 2
- The clinical characteristics of cluster headache in children and adolescents are similar to those in adults, including unilateral pain, autonomic manifestations, and severe intensity 3
- Symptoms of cluster headache in children include: + Pain occurring at night or on waking up (76.5%) 3 + 1 to 3 attacks per day (62.7%) lasting 30 to 120 minutes (68.6%) 3 + Unilateral headaches (90.2%) with a pulsatile character (64.7%) and severe intensity (100%) 3 + Autonomic manifestations (90.2%) predominantly ipsilateral to pain, including lacrimation, conjunctival injection, nasal congestion, ptosis, eyelid oedema, and rhinorrhoea 3
- Diagnosis of cluster headache in children can be difficult, especially in the first few years of life, and may require a brain magnetic resonance imaging (MRI) scan to exclude structural mimics 4
Treatment of Cluster Headache in Children
- Treatment of cluster headache in children and adolescents is similar to that used in adults, including acute and preventive medications 3, 5
- Effective treatments for acute manifestations include sumatriptan and oxygen inhalation 3, 5
- Prophylaxis, corticosteroids, verapamil, and gabapentin are also effective in preventing cluster headache attacks in children 3
- Other medications, such as lithium, divalproex sodium, topiramate, and indomethacin, may be useful in some cases 2, 4