Background: Cluster headache (CH) is a rare cause of headache in children. Onset before 12 years of age is unusual, and long-term follow-up of pediatric cases has been not reported. Objectives: To report three cases of CH with onset at childhood and at least ten years of follow-up. Methods: Case report. Results: The first case is that of a 12-year-old boy with episodic CH with unilateral pain and striking, bilateral autonomic manifestations, remitted for over eight years. The second case is unique in that it reports a case of chronic CH in a 13-year-old boy with Down syndrome. The third case is that of a 9-year-old girl with episodic CH with remissions of 2 and 5 years. All cases had prominent autonomic features. The frequency and duration of the attacks were similar to those that have been reported in adults. Good response to indomethacin was obtained in two cases, although tolerability issues occurred in one. Conclusion: Sustained, long-term, medical and/or spontaneous remission occurs in CH of early onset. The phenotype and response to therapy in children, at least in these case examples, are similar to equivalent observations in adult patients with CH.
Long-term follow-up of bilateral hypothalamic stimulation for intractable cluster headache