Cluster headache in children and adolescents: a systematic review of case reports

Abstract

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. 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.

Clinical Reasoning: A Teenager With Right-Sided Headache and Periorbital Changes

“…Indomethacin has been reported to be effective in CH, especially in children and adolescents. 6 In addition, while obtaining a more detailed family history, it was revealed that grandmother's attacks were associated with ipsilateral ptosis, likely representing a TAC rather than trigeminal neuralgia as previously believed. Positive family histories have been reported in CH 7 and other TACs.…”

Pediatric Cluster Headache Case Series: Symptomatic Cases and the Migraine Relationship

“…The 24% prevalence of bilateral headaches in this study is similar to a previous study showing 18%. 3,6,9,15,17,36,37 Both cluster headache and migraine can have autonomic features. Bilateral autonomic features can be common in migraine.…”

“…9 It can have a circadian pattern, commonly waking individuals at night, and a seasonal pattern favoring spring or fall. 2,7,15 Risk factors for cluster headache include smoking, positive family history, alcohol consumption, head trauma, and childhood exposure to secondhand smoking. 9,[16][17][18][19] Migraine is a distinct primary headache disorder with criteria defined by ICHD-3 in Table 2.…”

Can a systematic review of case reports be useful? Quality matters

“…The paper by Bastos et al is a systematic review of case reports of cluster headaches in children and adolescents. 1 The authors followed good principles of systematic reviews including: (1) a clear research question; (2) no language limitation; (3) search in multiple databases including the gray literature; (4) search terms that could be repeated; (5) an explanation of their decision to only use case reports; (6) evaluation of the effectiveness of treatment; (7) multiple authors performing study selection and data extraction; and (8) describing their study populations in detail. Moreover, the authors used the framework developed by Murad et al 2 to evaluate the methodological quality of the case reports.Two critical items that would have improved this study's basic good scholarship would be an a priori protocol and a list of studies excluded at the full-text stage with reasons for exclusion.…”

“…The paper by Bastos et al. is a systematic review of case reports of cluster headaches in children and adolescents 1 . The authors followed good principles of systematic reviews including: (1) a clear research question; (2) no language limitation; (3) search in multiple databases including the gray literature; (4) search terms that could be repeated; (5) an explanation of their decision to only use case reports; (6) evaluation of the effectiveness of treatment; (7) multiple authors performing study selection and data extraction; and (8) describing their study populations in detail.…”