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Management of Trigeminal Autonomic Cephalalgias in Children and Adolescents

  • Trigeminal Autonomic Cephalalgias (M Matharu, Section Editor)
  • Published:
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Abstract

Primary headache disorders that are more frequently encountered in the paediatric population include migraine and tension-type headaches. The trigeminal autonomic cephalalgias (TACs), which includes cluster headache (CH), paroxysmal hemicrania (PH) and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), are rarely reported in the paediatric population. The 1-year prevalence of CH seems to be 0.03 %. The clinical features of childhood and adolescence onset CH seem to be similar to those of adult onset. Cranial autonomic features and restlessness seem to less prominent in children than in adults. When restlessness is present, it often manifests as thrashing around in children and can distract attention from the headache, thereby contributing to a delay in diagnosis. The frequency of cluster periods seems to be lower in childhood. Similarly, the duration of the single cluster period seems to be shorter. The temporal pattern shows a trend towards a gradual increase of frequency and duration of symptoms in adult life. In terms of management of paediatric CH, oxygen has been used successfully in several paediatric CH patients, and given its good side-effect profile, it is considered the abortive agent of choice for paediatric CH. Verapamil is the preventative drug of choice in both episodic and chronic CH, though paediatric patients should be started on lower doses and titrated according to age. Paediatric-onset PH and SUNCT are very rarely reported. The clinical phenotype and response to treatment seem to resemble the adult-onset form. Paediatric-onset TACs are poorly recognized and there is often a delay of several months or years before the diagnosis is made. Awareness of typical clinical pictures of these excruciating headaches is essential to allow prompt initiation of the appropriate management.

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Conflict of interest

Dr. Giorgio Lambru declares that he has no conflict of interest.

Dr. Manjit Matharu is a section editor for Current Pain and Headache Reports. He is a board member for Allergan Ltd. He has received a grant from St. Jude Medical and honoraria from Merck Sharpe Dohme. He has also received payment for development of educational presentations including service on speakers’ bureaus from St. Jude Medical and Allergan Ltd.

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  1. Headache Group, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK

    Giorgio Lambru & Manjit Matharu

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  1. Giorgio Lambru
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  2. Manjit Matharu
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Correspondence to Manjit Matharu.

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This article is part of the Topical Collection on Trigeminal Autonomic Cephalalgias

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Lambru, G., Matharu, M. Management of Trigeminal Autonomic Cephalalgias in Children and Adolescents. Curr Pain Headache Rep 17, 323 (2013). https://doi.org/10.1007/s11916-013-0323-1

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