Antihistamine Responsive Cluster Headache in a Teenaged Girl

Abstract

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 Ioratadine, 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, antihestamines should have their place, especially in those cases where clinical evidence may suggest histamine involvement.Key words: cluster headache, childhood, Ioratadine prophylaxis, urinary methylhistamine (Headache 1997;37:296-298) Episodic cluster headache is defined as a severe unilateral head or facial pain, which lasts from 15 minutes to 3 hours and is commonly associated with conjunctival injection, lacrimation, and nostril blockage on the same side. Attacks can occur once or several times daily for a period of weeks or months. 1 Attacks with the same characteristics but of briefer duration and recurring more frequently (up to 30 times) during the day were named chronic paroxysmal hemicrania (CPH) by Sjaastad and Dale in 19762 and were reported to respond well to indomethacin. Also an episodic form was recognized with very frequent daily attacks lasting for a few weeks followed by a long symptom-free period with relapses only after months or even years. 3 To avoid different terminology for all these forms, the term "cluster headache syndrome" was proposed. 4 The pathophysiology of cluster headache is still unclear. Histamine-induced attacks in susceptible individuals were recognized in 1941 by Horton 5 whose name is sometimes used as an eponym for this type of headache. Some authors have detected high levels of histamine in blood during the attacks, 6,7 but treatment with antihistamine drugs was usually described as useless in such cases. 8 CASE HISTORYA 12-year-old girl was referred to our outpatient department with possible trigeminal neuralgia. Detailed history revealed that she had been suffering for more than a year from occasional paroxysmal attacks of right-sided hemicrania associated with ipsilateral itching of facial skin and clearly demarcated areas of purple-redness. These attacks usually lasted for 15 minutes, but were occasionally prolonged up to 2 hours and resolved spontaneously. Up to four attacks could occur in a day in a cluster manner. Remissions between the attacks were of variable duration, not exceeding 3 months. N...

Cluster headache-like disorder in childhood

“…Previous authors1 2have suggested that, although symptoms may begin in childhood, the diagnosis often goes unrecognised.…”

A Case Report: Cluster Headache in Childhood

“…No controlled study has been reported. Interestingly, a study in which a 12-year-old female was treated with antihistamine prophylaxis, first with astemizole and then with loratadine for 2 years, demonstrated this regimen to be effective [8]. Our case underwent also consecutive trials of, antihistamine prophylaxis (cyproheptadine hydrochloride 4 mg/day), flunarizine (5 mg/day), verapamil (80 mg/day), without efficacy.…”

Overview of diagnosis and management of paediatric headache. Part II: therapeutic management

“…According to these data, the most effective symptomatic treatments are oxygen [79–82], sumatriptan [81, 83] and acetylsalicylic acid [80–84]. Prophylactic treatments reported in literature are prednisone/prednisolone [85, 86], indomethacin [84], pizotifen [81], verapamil [81, 82, 87], methysergide [79, 83, 85], loratadine [88], astemizole [88] and flunarizine [89]. No controlled study has been reported.…”