Adult-Onset versus Pediatric-Onset Episodic Cluster Headaches: Results from the Korean Cluster Headache Registry

Purpose: This study aimed to compare clinical characteristics between pediatric-onset and adult-onset cluster headache (CH) using data from the Korean Cluster Headache Registry, a nationwide, prospective, multicenter registry.Methods: This cross-sectional observational study analyzed data collected over a 4-year period from a prospective multicenter registry. A total of 337 patients aged ≥19 years with episodic CH were included. Participants were classified as having pediatric-onset CH (onset≤18 years) or adult-onset CH (onset>18 years). Demographic and clinical features, smoking status, and psychiatric comorbidities were compared between groups.Results: Pediatric-onset CH was reported in 24.6% of patients (n=83). The diagnostic delay was significantly longer in the pediatric-onset group compared with the adult-onset group (10.1 years vs. 6.2 years, p<0.001). Patients with pediatric-onset CH experienced more severe headache attacks (numerical rating scale 9.2 vs. 8.9, p=0.025), although attack duration, frequency, and other clinical features were similar between groups. Smoking exposure was lower in the pediatric-onset group, suggesting potential differences in environmental risk factors. No significant differences were observed in psychiatric comorbidity or headache-related disability.Conclusion: Pediatric-onset CH is relatively common and shares most clinical features with adult-onset CH, apart from greater attack severity and lower smoking exposure. The longer diagnostic delay in pediatric-onset cases highlights the need for improved awareness and earlier recognition. Further research is warranted to elucidate the underlying pathophysiological mechanisms and long-term outcomes in pediatric-onset CH.