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Cluster headache in children and adolescents: a systematic review of case reports
Sarah N M A N Bastos1,2, Bárbara L F Barbosa1,2, Sângela F Silva3
1Department of Neurology, Federal University of Delta of Parnaíba, Parnaíba, Brazil.
Insights
Pediatric cluster headache shares clinical features and treatments with adult forms, though diagnosis can be challenging in young children. This systematic review highlights similarities and effective therapeutic options for managing this condition in youth.
Area of Science:
- Neurology
- Pediatrics
- Clinical Medicine
Background:
- Cluster headache is a debilitating neurological disorder characterized by severe unilateral head pain and autonomic symptoms.
- Pediatric cluster headache is rare and often misdiagnosed, leading to delayed treatment and significant impact on quality of life.
- Understanding the specific clinical presentation and effective management strategies in children is crucial for improving patient outcomes.
Purpose of the Study:
- To systematically review and describe the clinical characteristics of cluster headache in pediatric patients.
- To identify and evaluate the therapeutic options for acute and prophylactic treatment of cluster headache in children and adolescents.
Main Methods:
- A systematic literature review was conducted using PubMed, LILACS, and Web of Science databases.
- Case reports of pediatric cluster headache published between 1990 and 2020 were selected and analyzed.
- Data extraction focused on patient demographics, clinical features, diagnostic delay, and treatment efficacy.
Main Results:
- Fifty-one pediatric patients (mean age 9 years 7 months) were included, with a mean diagnostic delay of over two years.
- Typical presentation included nocturnal attacks, unilateral pulsatile severe headaches, and ipsilateral autonomic symptoms (lacrimation, conjunctival injection, rhinorrhea).
- Sumatriptan and oxygen were effective for acute attacks; prophylaxis with corticosteroids, verapamil, and gabapentin showed promise.
Conclusions:
- Pediatric cluster headache exhibits clinical characteristics and treatment responses similar to adult forms.
- Early diagnosis and appropriate management, mirroring adult protocols, are essential for effective care.
- Further research is needed to establish robust evidence for prophylactic treatments in this population.
Aim:
To describe the clinical characteristics and therapeutic options available to paediatric patients with cluster headache.
Method:
Based on a literature search of the medical databases PubMed, LILACS, and Web of Science and using selected descriptors, we carried out a systematic review of case reports on cluster headache in paediatric patients published from 1990 to 2020.
Results:
Fifty-one patients (29 males, 22 females) with a mean (SD) age of 9 years 7 months (3y 10mo; range 2-16y) were diagnosed with cluster headache. The mean (SD) diagnosis was made 27.8 months (26.2mo) after the onset of cluster headache. Pain occurred at night or on waking up (76.5%) and consisted of 1 to 3 attacks per day (62.7%) lasting 30 to 120 minutes (68.6%). Headaches were unilateral (90.2%), had a pulsatile character (64.7%), and severe intensity (100%). There were autonomic manifestations (90.2%) predominantly ipsilateral to pain, in this order: lacrimation; conjunctival injection; nasal congestion; ptosis; eyelid oedema; and rhinorrhoea. Sumatriptan and oxygen inhalation were the most effective treatments for acute manifestation. Prophylaxis, corticosteroids, verapamil, and gabapentin were the most effective drugs.
Interpretation:
Due to the small number of published studies, this review could not provide reliable data; however, it appears that cluster headache in children and adolescents is similar to adults, both in clinical characteristics and treatment. What this paper adds Cluster headache in children and adolescents is poorly studied. Cluster headache is uncommon before 10 years of age and diagnosis is difficult in the first few years of life. Treatment of cluster headache in children and adolescents is similar to that used in adults. The notion of the effectiveness of prophylactic treatment is based only on authors' experience.
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