Trigeminal Autonomic Cephalalgias in Children and Adolescents: Cluster Headache and Related Conditions

https://doi.org/10.1016/j.spen.2015.08.002Get rights and content

Cluster headache is a primary headache disorder that can occur in children and adolescents, and is a member of the broader diagnostic group of trigeminal autonomic cephalalgias. It is characterized by repeated attacks typically lasting between 15 and 180 minutes of severe unilateral side-locked headache with cranial autonomic features. Acute treatment of the cluster attack can include the use of triptans or high-flow oxygen. Preventive measures typically start with the use of verapamil. The other trigeminal autonomic cephalalgias, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), and short-lasting unilateral neuralgiform headache with cranial autonomic features (SUNAA), have also been reported in children, and should be considered when the clinical presentation is at all unusual.

Section snippets

Cluster Headache

Cluster headache is the most common TAC. The prevalence in adults is <1% and has a male predominance.2 The prevalence in childhood and adolescence has been estimated to be 0.1%, based on a study of 18-year-old Swedish men.3 Studies have noted childhood onset at ages between 5 and 19 years. The current concept of cluster headache is as a central nervous system disorder involving an interaction between diencephalic pain modulatory centers in the hypothalamic region and the cranial autonomic

Paroxysmal Hemicrania and SUNCT-SUNA Syndrome

Paroxysmal hemicrania is said to be rare in children, although there are no data available and in specialist clinics their frequency seems similar to what can be seen in comparable adult clinics. Attacks of unilateral, often stabbing, headaches are shorter (2-30 minutes), and more frequent (typically more than 5 per day) than in cluster headaches.26 These headaches are exceptionally responsive to treatment with indomethacin.27 In adult patients, a typical indomethacin trial begins with 25 mg

References (30)

  • I. Talvik et al.

    Three-year follow-up of a girl with chronic paroxysmal hemicrania

    Pediatr Neurol

    (2009)
  • Headache Classification Committee of the International Headache Society

    The International Classification of Headache Disorders, 3rd edition (beta version)

    Cephalalgia

    (2013)
  • O. Sjaastad et al.

    Cluster headache prevalence. Vägä study of headache epidemiology

    Cephalalgia

    (2003)
  • K. Ekbom et al.

    Prevalence of migraine and cluster headache in Swedish men of 18

    Headache

    (1978)
  • P.R. Holland et al.

    Cluster headache, hypothalamus, and orexin

    Curr Pain Headache Rep

    (2009)
  • M. Barloese et al.

    Sleep and chronobiology in cluster headache

    Cephalalgia

    (2015)
  • M.C. Barloese et al.

    Sleep in cluster headache - beyond a temporal rapid eye movement relationship?

    Eur J Neurol

    (2015)
  • P.J. Goadsby

    Pathophysiology of cluster headache: A trigeminal autonomic cephalgia

    Lancet Neurol

    (2002)
  • M.B. Russell

    Epidemiology and genetics of cluster headache

    Lancet Neurol

    (2004)
  • M. Levy et al.

    The clinical characteristics of headache in patients with pituitary tumours

    Brain

    (2005)
  • A.A. Gelfand et al.

    Cranial autonomic symptoms in pediatric migraine are the rule, not the exception

    Neurology

    (2013)
  • A. Bahra et al.

    Cluster headache: A prospective clinical study in 230 patients with diagnostic implications

    Neurology

    (2002)
  • P. Irimia et al.

    Unilateral photophobia or phonophobia in migraine compared with trigeminal autonomic cephalalgias

    Cephalalgia

    (2008)
  • T.H. Lai et al.

    Cranial autonomic symptoms in migraine: Characteristics and comparison with cluster headache

    J Neurol Neurosurg Psychiatry

    (2009)
  • A.D. Nesbitt et al.

    Cluster Headache

    Br Med J

    (2012)
  • Cited by (17)

    • An unusual diagnostic route: Pediatric case of a mesencephalic cavernoma presenting as cluster headache

      2021, Interdisciplinary Neurosurgery: Advanced Techniques and Case Management
      Citation Excerpt :

      The underlying pathophysiology relies on the trigemino-autonomic reflex with afferent input originating in the two first divisions of the trigeminal nerve (ophthalmic branch V1 and maxillary branch V2) and parasympathetic efferent output transmitted by the facial nerve (VII) via the greater petrosal nerve, resulting in the autonomic symptoms mentioned above [3]. Cluster headaches are classified as trigeminal autonomic cephalalgia, which are per definition primary headaches [2]. However, a numbers of cases of inflammatory, vascular or neoplastic conditions have been reported to cause or mimic cluster headaches [4–9].

    • Child with New Onset Headache

      2023, Symptom-Based Approach to Pediatric Neurology
    View all citing articles on Scopus
    View full text