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Childhood-onset cluster headache
1Department of Neurology; Psychiatry and Pain Center; General Hospital, Linz, Austria.
Insights
Cluster headache, a severe neurological disorder, can affect children. This case study highlights a 7-year-old girl whose episodic cluster headaches were successfully treated with steroids after misdiagnosis.
Area of Science:
- Neurology
- Pediatrics
Background:
- Cluster headache is a primary headache disorder with established diagnostic criteria, typically emerging in the second decade of life.
- Childhood onset cluster headaches are rare, with a prevalence of approximately 0.1%.
Observation:
- A 7-year-old female presented with daily, severe, strictly unilateral orbital attacks lasting 30 minutes, accompanied by autonomic symptoms.
- Initial misdiagnosis as psychogenic headaches occurred, with no family history of headache disorders, normal neurological exams, and negative MRI findings.
- An indomethacin test was negative.
Findings:
- The patient met the diagnostic criteria for episodic cluster headaches according to the International Headache Society.
- Daily intravenous prednisolone administration effectively terminated the cluster headache attacks within three days.
Implications:
- This case underscores the importance of considering cluster headaches in pediatric patients with severe unilateral headaches and autonomic symptoms.
- Steroid therapy, specifically intravenous prednisolone, demonstrated efficacy in treating episodic cluster headaches in a child.
- Further review of pathogenesis, clinical features, and treatment options for pediatric cluster headaches is warranted.
Abstract:
Cluster headache, the most painful of the primary headaches, is a disorder with well-known diagnostic criteria. The condition usually begins in the second decade of life; the prevalence of childhood onset is approximately 0.1%. A 7-year-old female who suffered daily from severe strictly unilateral right orbital attacks lasting approximately 30 minutes associated with autonomic symptoms is reported herein. They were primarily misdiagnosed as psychogenic headaches. There was no family history for migraine or cluster headaches; physical and neurologic examinations and magnetic resonance imaging did not suggest any association with head trauma or vascular disorders. After a negative indomethacin test, daily intravenous administration of prednisolone terminated the attacks on the third day of the treatment. According to the classification and diagnostic criteria for headache disorders of the International Headache Society the child fulfilled the criteria for episodic cluster headaches. The pathogenesis, clinical manifestation, autonomic features, genetics, and family history of cluster headaches during childhood are reviewed in this report. Prophylactic medication and symptomatic treatment options are discussed, especially concerning the rationale of use of steroids in children with cluster headaches.