A case report of an adolescent with cluster headaches following neck trauma: Coincidence or trigger?

Abstract

Posttraumatic headaches usually have tension-type or migraine-like characteristics. A correlation between head trauma and cluster headaches (CH) has been previously reported. CH in children are rare and require thorough differential diagnosis. We present an original case of a 15-year-old boy with cluster headaches associated with allodynia probably evoked by a neck trauma. Severe headache attacks started one month after neck trauma. At the beginning clinical presentation of our patient's headaches was very misleading. Headaches were bilateral and associated with infection. Initial diagnosis of sinusitis was made. During further observation headaches have become unilateral with typical for CH associated symptoms and additionally with allodynia. Other causes of secondary CH like cervicogenic headaches, brain tumor and vascular malformation have been excluded. The boy has undergone prophylactic treatment based on flunarizine and gabapentin with good result. Possible pathogenesis of our patient's headaches has been proposed and diagnostic traps discussed.

Cluster Headache: Diagnosis, Management, and Treatment in Pediatric Headache

“…It seems that symptomatic cases in pediatric age may often be associated with a diagnosis of probable CH (as defined in ICHD-3) rather than fulfilling all the criteria [ 10 , 24 , 25 ]. Eberhard et al described five cases of symptomatic CH, but only one case of hypothalamic pilocytic astrocytoma with carotid stenosis presented all ICHD-3 criteria, the others being diagnosed respectively with Graves’ disease, atypical optic neuritis, prolactinoma, and congenital right eye blindness ipsilateral to the attacks [ 10 ].…”

“…Gabapentin was effective in six out of seven cases in which it was used [ 10 , 16 , 24 , 25 ]. Out of the seven cases, three were reported as symptomatic but fulfilled all the criteria required for a diagnosis of CH.…”

“…Usual pediatric doses range from 8 to 35 mg/kg/day divided in three doses, but gabapentin must be initiated with 5 mg/kg in a single dose and adding one dose every day until the third day of therapy. Ataxia, dizziness, drowsiness, and fatigue are some of the common adverse effects [ 24 , 25 ].…”

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

“…Treatment of cluster headache in children and adolescents is based on experience in adult patients and is divided into three stages: acute; preventive; or transitional. During pain attacks, the most effective abortive agents in most patients are inhalation of 100% oxygen – between 7L/min and 12L/min for 15 to 30 minutes through a face mask – and subcutaneous and intranasal triptans 3,8–14 . Verapamil, lithium, topiramate, gabapentin, indomethacin, and valproic acid/sodium valproate are the most used prophylactics 2,3,5,6,9–12,15,16 .…”

Cefaleia em Salvas em Crianças e Adolescentes: Uma revisão sistemática de relatos de casos

“…O tratamento da cefaleia em salvas em crianças e adolescentes é baseado na experiência em pacientes adultos e é dividido em três fases: aguda, preventiva ou transição. Durante as crises de dor, os agentes abortivos mais eficazes na maioria dos pacientes são a inalação de oxigênio a 100%, entre 7L/min e 12L/min por 15 a 30 minutos através de uma máscara facial ‐ e triptanos subcutâneos e intranasais 3,8–14 . Verapamil, lítio, topiramato, gabapentina, indometacina e valproato são os profiláticos mais utilizados 2,3,5,6,9–12,15,16 .…”