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Wilson Disease – Paradoxical Worsening on Penicillamine — SCE Neurology MCQ

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HardMovement DisordersWilson Disease – Paradoxical Worsening on PenicillamineSCE Neurology

A patient has entered a new episodic cluster-headache bout with six attacks nightly. Subcutaneous sumatriptan and high-flow oxygen abort attacks, and verapamil has just started with ECG-guided titration. Oral corticosteroids are unsuitable because of previous severe systemic adverse effects. Which BASH-supported alternative short-term bridge is most appropriate while verapamil is titrated?

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

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Correct answer: A — Use a greater-occipital-nerve block with local anaesthetic and depot corticosteroid

A greater-occipital-nerve block with local anaesthetic and depot corticosteroid is the BASH-supported alternative to oral corticosteroids for short-term prevention and can minimise systemic corticosteroid exposure while verapamil is titrated. An oral prednisolone taper conflicts with the stated intolerance. Topiramate and lithium are preventive alternatives rather than established temporary bridges, and galcanezumab is not a routine NHS-funded bridging treatment for cluster headache.

Reference: BASH guideline: cluster headache (BASH guideline version 2.0, current in 2026): https://bash.org.uk/2-4-1-cluster-headache/