Childhood-onset cluster headache.

Cluster headache, the most painful of the primary headaches, is a disorder with well-known diagnostic criteria. The condition usually begins in the second decade of life; the prevalence of childhood onset is approximately 0.1%. A 7-year-old female who suffered daily from severe strictly unilateral right orbital attacks lasting approximately 30 minutes associated with autonomic symptoms is reported herein. They were primarily misdiagnosed as psychogenic headaches. There was no family history for migraine or cluster headaches; physical and neurologic examinations and magnetic resonance imaging did not suggest any association with head trauma or vascular disorders. After a negative indomethacin test, daily intravenous administration of prednisolone terminated the attacks on the third day of the treatment. According to the classification and diagnostic criteria for headache disorders of the International Headache Society the child fulfilled the criteria for episodic cluster headaches. The pathogenesis, clinical manifestation, autonomic features, genetics, and family history of cluster headaches during childhood are reviewed in this report. Prophylactic medication and symptomatic treatment options are discussed, especially concerning the rationale of use of steroids in children with cluster headaches.