skip to main content

Cluster Headache — SCE Neurology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateHeadache & Facial PainCluster HeadacheSCE Neurology

A 35-year-old man presents with excruciating unilateral right periorbital pain lasting 45–90 minutes, occurring 3 times daily for the past 4 weeks. He has associated ipsilateral lacrimation, conjunctival injection, and nasal congestion. Between attacks he is pain-free. What is the most appropriate acute treatment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Subcutaneous sumatriptan 6 mg and/or high-flow oxygen at 12–15 L/min

The presentation is classic for episodic cluster headache. Acute treatment per NICE CG150 and ABN headache guidelines is subcutaneous sumatriptan 6 mg and/or 100% oxygen at 12–15 L/min via a non-rebreathable mask for 15–20 minutes. Oral triptans are too slow in onset for cluster attacks. A: Oral sumatriptan has insufficient speed of onset. C: Simple analgesics are ineffective for cluster headache. D: Indomethacin is the treatment for paroxysmal hemicrania, not cluster headache. E: Prednisolone is used as a transitional/bridge therapy, not as acute treatment.

Reference: NICE CG150 Headaches (2012, updated 2021); ABN Headache Guidelines