Antihistamine responsive cluster headache in a teenaged girl

Episodic cluster headache is a well-recognized entity usually starting in the second decade of life. Uncommonly, the first typical symptoms may present in the first decade of life, but are rarely recognized as such during childhood. We report a 12-year-old girl who presented with a 1-year history of bouts of right-sided hemicrania with ipsilateral, clearly demarcated, redness and itching of the skin of the face, lasting from 15 minutes to 2 hours per day. The episodes recurred up to several times daily for a few days and were followed by remissions lasting up to 2 months. Thorough investigations failed to prove any definite cause. Antihistamine prophylaxis, first with astemizole and then with loratadine, proved to be very effective. During the follow-up period of more than 3 years, such a prophylactic regimen provided excellent relief, with only two relapses due to noncompliance. We suggest that in a sequential treatment trial for cluster headache during childhood, antihistamines should have their place, especially in those cases where clinical evidence may suggest histamine involvement.