Cluster headaches in a 17 year-old

Our 17-year-old son has bursts of headaches. They are severe and come out of nowhere. The pain is around his eye, which runs as does his nose. He can have 4 a day for several weeks and they last for half an hour or longer. He becomes very agitated with them. Is this migraine?

We have an expression in Medicine “Are you a lumper or a splitter?” By this we mean some doctors will lump closely related conditions all in the same box and then say there are variations. Other doctors split conditions into finer and finer categories. The lumpers would say that your son’s condition is a form of migraine. The splitters would say this as a Cluster Headache. Both groups agree that whether migraine or cluster headaches, both are due to changes in the size of blood vessels inside the head.

Cluster headaches are commoner in males than females but occur in both sexes. Although mainly around the eye and temple, they can spread to other parts of the head. The pain is sudden and severe with no warning. It usually lasts half to 2 hours and may be accompanied by watering of 1 eye and nostril. The commonest time for them is at night. The bouts usually last a month or 2 with the patient being well in between for up to 6-12 months.

Preventer medication can be used during the bouts and pain relievers do help the pain when it occurs. There is sometimes an obvious trigger with perhaps the most frequent being alcohol; during the bad month. If such a trigger is identified it should be avoided during the bouts.

High Blood Pressure at 15 years

My 15-years-old daughter has been complaining of headaches and was found to have high blood pressure. Isn’t she too young to have high blood pressure?

High blood pressure is much less common in children and adolescents than in adults but it does occur. In younger people it is important to look for an underlying cause such as kidney disease, narrowing of important arteries and other conditions which are causing “secondary high blood pressure”. I well remember a young nurse who told me that her doctor was treating her with high blood pressure pills. I encouraged her to have someone look for an underlying cause. She was found to have a narrowing of the main artery to one of her kidneys. The narrowing was repaired at operation and she has had no problem with her blood pressure since.

Measuring blood pressure in children and adolescents can be tricky. If one uses an arm cuff that is too small for the patient’s arm, a false high value can be obtained. Also, at any age, if one is nervous then blood pressure goes up moderately.

I think your daughter should have her blood pressure checked again and if it is still high, she should see a specialist to arrange tests looking for an underlying cause.