What are the symptoms and treatment options for Cluster Headaches (CH) in pediatric patients?

From the Guidelines

Cluster headaches in children should be treated with high-flow oxygen therapy (12 L/min via a non-rebreather mask) as the first-line treatment for acute attacks, as recommended by the British Thoracic Society guidelines 1. When managing cluster headaches in kids, it's essential to consider the severity of symptoms and the impact on quality of life. Key characteristics of cluster headaches include severe one-sided pain around the eye, accompanied by redness, tearing, nasal congestion, and restlessness.

• Treatment approaches typically involve both acute and preventive strategies.
• For acute attacks, high-flow oxygen therapy (12 L/min via a non-rebreather mask) is considered the most effective treatment, providing relief within a short period, as supported by the British Thoracic Society guidelines 1.
• Preventive treatments during cluster periods may include short-term corticosteroids, verapamil, or topiramate, but these should be individualized and monitored by a pediatric neurologist.
• Parents should maintain a headache diary to identify potential triggers, such as sleep disruption or stress, to help manage the condition and improve quality of life.
• Due to the complexity and severity of cluster headaches, children with suspected cluster headaches should be evaluated by a pediatric neurologist to develop an effective treatment plan and monitor for medication side effects.

From the Research

Cluster Headache Symptoms

• Cluster headache is characterized by severe or very severe, strictly unilateral pain, which is orbital, supraorbital, or temporal pain, lasting 15 to 180 minutes and occurring from once every other day to eight times daily 2
• The pain is very intense, usually increases in intensity very rapidly from onset, and attacks are often frequent 3

Treatment Options for Cluster Headache

• Acute treatment options include:
  • Inhalation of 100% oxygen 4, 5, 3, 2
  • Subcutaneous administration of sumatriptan 4, 5, 3, 6, 2
  • Intranasal application of sumatriptan or zolmitriptan 4, 3, 2
• Preventive treatment options include:
  • Verapamil 4, 5, 3, 6, 2
  • Lithium 4, 3, 6, 2
  • Gabapentin, topiramate, divalproex sodium, and melatonin may also be effective 4, 2
• Transitional therapy options include:
  • Short courses of high-dose oral corticosteroids 3, 6
  • Dihydroergotamine 3
  • Occipital nerve blocks with local anesthetic and steroids 3

Treatment Considerations

• The choice of treatment should be based on the individual patient's needs and medical history 5, 3, 6
• Lifestyle changes, including alcohol avoidance during the active phase of the disease, sleep hygiene, and use of vasodilation drugs, should be carefully considered and the patients should be fully informed 6