OC-19 | A multicenter, retrospective case series of trigeminal autonomic cephalalgias in children and adolescents

Alessandro Borrelli,¹ Vittorio Sciruicchio,² Alessandro Ferretti,³ Irene Toldo,⁴ Antonia Versace,⁵ Elisabetta Tozzi,⁶ Agnese Onofri,⁷ Giorgia Sforza,¹ Gabriele Monte,¹ Fabiana Ursitti,¹ Massimiliano Valeriani,^1,8,9 Laura Papetti¹ | ¹Developmental Neurology Unit, IRCCS Bambino Gesù Children's Hospital, Rome; ²Children Epilepsy and EEG Center, San Paolo Hospital, ASL Bari;³Department of Neuroscience, Mental Health & Sense Organs (NESMOS), Faculty of Medicine & Psychology, Sant'Andrea Hospital, Rome; ⁴Pediatric Neurology and Neurophysiology Unit, Department of Woman's and Child Health, University of Padua; ⁵A.O.U. Città della Salute e della Scienza di Torino, Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin; ⁶Department of Clinical Medicine, Public Health, Life and Environmental Sciences, L'Aquila; ⁷Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy; ⁸Tor Vergata University of Rome, Systems Medicine Department, Rome, Italy; ⁹Aalborg University, Center for Sensory-Motor Interaction, Aalborg, Denmark

Background: Trigeminal autonomic cephalalgias (TACs), encompassing cluster headache (CH), paroxysmal hemicrania (PH), hemicrania continua (HC), and short-lasting unilateral neuralgiform headache attacks (SUNCT/SUNA), are rare primary headache disorders during developmental age. Their diagnosis in this age group is challenging due to their rarity, limited awareness by medical professionals, and possibly to atypical characteristics, that might limit their recognition in children and adolescents.

Methods: We conducted a retrospective review using hospital electronic medical records and personal clinical encounters to identify patients diagnosed with TACs before the age of 18. Our study population was composed of patients evaluated in six Italian developmental age headache centres. Inclusion required fulfilment before the age of 18 of criteria for TACs or for probable TACs, as defined in the International Classification of Headache Disorders, 3rd edition (ICHD-3). Clinical features, treatment responses and treatment outcomes were analysed.

Results: The study included 33 paediatric patients with TACs: 19 with CH, 4 with PH, 3 with HC and 7 with SUNA, evaluated from 2005 to 2024. The majority of CH patients were of female sex. PH and SUNA showed a lower frequency of headache attacks than described in ICHD-3 criteria. The most effective treatments for CH attacks were 100% oxygen or corticosteroids in the acute setting and verapamil for prevention. Response to indomethacin was observed in PH and HC, though responsiveness was occasionally reported also in patients with CH and SUNA. Various other treatment options were attempted, yielding variable results.

Conclusion: Differences in certain clinical characteristics of TACs between developmental and adult age groups appear to exist. However, specific treatment recommendations for TACs during childhood and adolescence, other than for cluster headache (CH) , are lacking. By reporting a substantial number of TACS cases, we aim to contribute to a better understanding of these disorders in these age groups.