What should you know about pediatric cluster headaches?

An attack may centre around one eye or temple and can bring tearing, a blocked or runny nostril, facial sweating, or restlessness on the same side. Attacks often follow a recognisable pattern and may recur at similar times, but children can describe head pain less clearly than adults. Migraine, sinus problems, eye conditions, infection, and other causes can resemble this pattern, so a clinician should not diagnose cluster headache from one symptom alone.

Keep a record of the pain side, start time, duration, associated eye or nose changes, sleep disruption, and possible triggers. This gives the clinician useful information without suggesting that every headache is a cluster headache.

Arrange a GP consultation for a child with repeated severe headaches, especially when pain is focused around one eye or accompanied by tearing or nasal symptoms. During an episode, keep the child in a calm, safe space and note what you observe. Do not give a child someone else’s prescription medicine or increase a dose without medical advice. The clinician may review the examination, headache pattern, medicines, sleep, and family history before discussing treatment or referral.

Seek urgent medical help for a sudden, explosive headache, new weakness, confusion, fainting, trouble speaking, a stiff neck, repeated vomiting, a severe headache after a head injury, or a painful red eye with vision change. Emergency care is also appropriate when a child is unusually difficult to wake or appears seriously unwell with fever. These warning signs are reasons for immediate assessment, regardless of whether cluster headache has been considered.

Ask whether the pattern fits cluster headache or another headache disorder, whether an eye or neurological examination is needed, which medicines are suitable for the child, and what symptoms should prompt emergency care.