A Systematic Review of Cluster Headache Among the Pediatric Population

frustrated adolescent, headache, homework
The researchers’ goal was to describe the clinical characteristics and therapeutic options available to pediatric patients with cluster headache.

The clinical characteristics of cluster headache and the treatments for it among the pediatric population are likely similar to those of adults, but few studies have been published to justify these claims. These findings from a systematic review were published in Developmental Medicine and Child Neurology.

Researchers in Brazil searched publication databases for studies of cluster headache among children and adolescents. A total of 18 articles comprising 51 patients were included in this review.

The 29 boys and 22 girls were diagnosed with cluster headache at an average age of 9 years and 7 months (range, 2-16 years) after onset of symptoms at an average age of 8 years and 8 months (range, 3 months-16 years).

Most patients reported experiencing attacks at night or upon waking (76.5%), attacks that lasted 30 to 120 minutes (68.6%), and from 1 to 3 daily attacks (62.7%). Headaches were frequently experienced unilaterally (90.2%) with throbbing or pulsating pain (64.7%), and were associated with autonomic manifestations (90.2%).

Autonomic manifestations included lacrimation (60.8%), conjunctival injection (56.9%), nasal congestion (31.4%), ptosis (31.4%), eyelid edema (23.5%), rhinorrhea (7.8%), forehead and facial sweating (3.9%), and miosis (3.9%). Other symptoms included photophobia (47.1%), phonophobia (31.4%), nausea (13.7%), vomiting (3.9%), and dizziness (3.9%).

Successful abortive therapies included oxygen inhalation (response rate, 78.6%), sumatriptan nasal spray (response rate, 77.8%), and ergotamine derivatives (response rate, 66.7%). Less successful responses were observed from other triptans (response rate, 33.3%), nonsteroidal anti-inflammatory drugs (response rate, 22.2%), and acetaminophen or dipyrone (response rate, 20.0%).

Successful prophylactic treatments included verapamil (100.0%), gabapentin (100.0%), methysergide (100.0%), indomethacin (90.0%), valproic acid or sodium valproate (75.0%), pizotifen (66.7%), lithium (66.7%), and topiramate (66.7%).

Methysergide was removed from the market 10 years ago due to adverse events.

This review was limited by the lack of population-based studies.

These data suggest that the clinical characteristics of cluster headaches and their therapeutic options were similar among pediatric and adult populations. Additional studies are needed to better assess cluster headache among children.


Bastos SNMAN, Barbosa BLF, Silva SF, et al. Cluster headache in children and adolescents: a systematic review of case reports. Dev Med Child Neurol. Published online May 14, 2021. doi:10.1111/dmcn.14923