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Childhood onset cluster headaches
J Maytal1, R B Lipton, S Solomon
1Department of Neurology, Montefiore Medical Center, Bronx, New York.
Insights
Childhood cluster headaches, a rare condition, present similarly to adult forms. Over time, these severe headaches can increase in frequency and duration, highlighting the need for early diagnosis and treatment.
Area of Science:
- Neurology
- Pediatrics
Background:
- Cluster headaches are uncommon in children and adolescents.
- Diagnosis can be delayed, with patients seeking medical attention years after symptom onset.
Purpose of the Study:
- To describe the clinical features and long-term evolution of cluster headaches in pediatric patients.
- To compare childhood-onset cluster headaches with the adult form of the disease.
Main Methods:
- Retrospective review of 35 patients diagnosed with cluster headaches before age 18.
- Follow-up data collected over 18 years to track changes in headache patterns.
Main Results:
- Clinical presentation in children mirrored adult cluster headaches.
- Over time, 14 subjects showed increased frequency and duration of cluster periods.
- The frequency of individual headache attacks also increased in many patients.
Conclusions:
- Cluster headaches in childhood and adolescence resemble the adult presentation.
- Headache frequency and duration can worsen over time in pediatric patients.
- Cluster headaches are an under-recognized, treatable cause of severe headaches in youth.
Abstract:
Cluster headaches are rare in childhood. We identified 35 patients with cluster headaches starting at or before 18 years of age, including 7 patients with onset prior to age 10. All patients met the criteria of the International Headache Society for episodic or chronic cluster headaches. Patients experienced cluster headaches for as long as 20 years before seeking medical attention and required many medical contacts to establish the correct diagnosis. The clinical features of cluster headaches during childhood were similar to those which typically occur in adult life. Cluster headache patterns changed over 18 years of follow up. The frequency and duration of cluster periods increased in 14 subjects. The frequency of single headache attacks during cluster periods also increased in a similar number of subjects. We conclude that cluster headaches starting in childhood or adolescence closely resemble the adult form of the disease. In many patients, the frequency and duration of cluster periods and the frequency of the individual headache episodes increased over time. Cluster headache represent a treatable under-recognized cause of severe headaches in childhood and adolescence.