Cluster headaches similar to the typical adult form occurred in 35 patients at or before 18 years of age in a study from the Montefiore Medical Center and Schneider Children’s Hospital, New York. The mean age at onset was 14 years (range 5-18). The delay from onset to diagnosis ranged from 0 to 34 years (mean 8 years). Pain was ocular in 88% and lacrimation occurred in 85%. Ptosis was present in 48% and nasal congestion in 60%. A family history of migraine occurred in 9 patients and a family history of cluster headaches in 3. The frequency and duration of cluster periods increased with age in 14. [1]

COMMENT. Familial cluster headache occurring in 3 generations is reported from the Brigham and Women’s Hospital, Boston [2]. The child, an 8-year-old boy, had suffered from headaches since age 4; the father age 42, and the paternal grandfather age 73, had cluster headache also. Three pairs of identical twins with cluster headache have been reported, suggesting a genetic factor in predisposition. [3, 4]