Red flags & when to go in person for Cluster Headache - Triage

Audience: pediatric

Cluster headaches are severe headaches that often occur in groups or "clusters." In children, these headaches can be very painful and may cause other symptoms like eye redness or tearing. While telemedicine can help you understand symptoms and decide next steps, some warning signs mean your child should see a healthcare provider in person right away. This guide explains when to seek urgent care and what to expect during telemedicine visits. It also helps families prepare for appointments and understand what telemedicine can and cannot do. Remember, this information is for education and does not replace medical advice or diagnosis from a healthcare professional.

Red flags — go in person / ER

• Sudden, severe headache unlike any before — seek emergency care immediately.
• Headache accompanied by fever, stiff neck, confusion, weakness, or difficulty speaking — go to emergency services.
• Headache following a head injury — urgent in-person evaluation needed.

What telemedicine can do

• Discussing headache symptoms and history.
• Providing guidance on symptom management.
• Determining if urgent in-person care is needed.
• Answering questions about cluster headaches.

What telemedicine cannot do

• Performing physical neurological exams.
• Ordering or conducting imaging tests.
• Administering emergency treatments.
• Diagnosing serious underlying conditions requiring immediate care.

What is a Cluster Headache?

Cluster headaches are intense headaches that usually happen on one side of the head, often around the eye. They can last from 15 minutes to 3 hours and may happen several times a day in groups called clusters. In children, these headaches are less common but can be very painful and may include symptoms like red or watery eyes, nasal congestion, or restlessness.

When to Seek In-Person Care

Certain signs mean your child needs to see a healthcare provider in person as soon as possible. These include:

If your child shows any of these signs, go to the nearest emergency room or urgent care center immediately.

How Telemedicine Can Help

Telemedicine can be useful for:

During a telemedicine visit, the provider may ask detailed questions and observe your child to help guide care.

Limitations of Telemedicine for Cluster Headaches

Telemedicine cannot:

If your child’s symptoms suggest a serious problem, an in-person visit is necessary.

Preparing for a Telemedicine Visit

Before the visit:

After the Telemedicine Visit

After the visit, you may:

Keep a headache diary to track any changes and share this with your healthcare provider.

How to prepare for your tele-visit

• List all current symptoms and their timing.
• Note any recent injuries or illnesses.
• Prepare a list of current medications and doses.
• Find a quiet, well-lit space with good internet connection.
• Have a device ready for video calls (smartphone, tablet, or computer).
• Be ready to describe any changes in behavior or new symptoms.

After your tele-visit

• Follow the healthcare provider’s advice on managing symptoms.
• Schedule an in-person visit if recommended.
• Monitor for any new or worsening symptoms.
• Keep a headache diary to track frequency and severity.
• Seek emergency care if red flags develop after the visit.

FAQs

What causes cluster headaches in children?

The exact cause of cluster headaches is not fully understood. They may involve changes in the brain’s blood vessels and nerve pathways. In children, cluster headaches are rare but can be triggered by factors like stress or changes in sleep patterns.

Can cluster headaches be treated at home?

Some symptoms may be managed at home with rest and avoiding known triggers. However, because cluster headaches are very painful and can affect daily activities, it’s important to consult a healthcare provider for proper diagnosis and treatment options.

When should I call emergency services for my child’s headache?

Call emergency services immediately if your child has a sudden, severe headache unlike any before, especially if it comes with fever, neck stiffness, confusion, weakness, difficulty speaking, or if it follows a head injury.

Are cluster headaches the same as migraines?

Cluster headaches and migraines are different types of headaches. Cluster headaches are usually shorter but extremely painful and occur in groups. Migraines often last longer and may include nausea or sensitivity to light and sound.

Can telemedicine replace all in-person visits for headaches?

Telemedicine is helpful for initial assessments and follow-up discussions but cannot replace all in-person visits, especially if physical exams or tests are needed to rule out serious conditions.

Sources

1. Cluster Headache — MedlinePlus, U.S. National Library of Medicine.
2. Headache in Children and Adolescents — American Academy of Pediatrics (AAP).
3. Cluster Headaches: Symptoms and Causes — Mayo Clinic.
4. Telemedicine: What You Need to Know — Centers for Disease Control and Prevention (CDC).

This telemedicine guidance is for educational purposes only and is not a substitute for professional in-person medical care. If your child has concerning symptoms or emergencies, seek immediate in-person evaluation.