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Cluster Headache – Preventive Therapy — SCE Neurology MCQ

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ModerateHeadache & Facial PainCluster Headache – Preventive TherapySCE Neurology

A 42-year-old man presents with a 2-day history of severe unilateral right periorbital pain occurring in bouts of 60–90 minutes, 4–6 times daily, with ipsilateral conjunctival injection, lacrimation, and nasal congestion. He has had similar clusters each spring for 5 years. Between cluster periods he is entirely well. His neurologist wishes to start preventive therapy for the current bout. What is the first-line preventive medication for episodic cluster headache?

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Correct answer: C — Verapamil

Verapamil is the first-line preventive medication for episodic cluster headache per NICE CG150 and ABN headache guidelines. It reduces the frequency and severity of attacks during a cluster bout. An ECG should be checked before and after dose increases due to the risk of heart block. A: Propranolol is for migraine prophylaxis, not cluster headache. C: Topiramate is a second-line option for cluster headache. D: Lithium is used for chronic cluster headache. E: Amitriptyline is for migraine/tension-type headache prophylaxis.

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