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Chronic Cluster Headache – Lithium — SCE Neurology MCQ

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ModerateHeadache & Facial PainChronic Cluster Headache – LithiumSCE Neurology

A 55-year-old man with chronic cluster headache (continuous for >1 year without remission lasting ≥3 months) has failed verapamil, lithium, topiramate, and greater occipital nerve blocks. What is the role of lithium in chronic cluster headache?

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Correct answer: A — Lithium is specifically recommended for chronic cluster headache (not episodic) as prophylactic therapy — it requires monitoring of serum levels, renal function, and thyroid function

Lithium is specifically positioned for chronic cluster headache (CCH) prophylaxis. Evidence suggests it is more effective for chronic than episodic cluster headache (where verapamil is first-line). Lithium requires careful monitoring: serum levels (0.4–1.0 mmol/L), renal function (can cause nephrogenic DI and renal impairment), thyroid function (can cause hypothyroidism), and cardiac monitoring. A: Lithium is for chronic CH, not episodic (verapamil is first-line for episodic). C: It is specifically indicated. D: It has broader neurological uses. E: It is prophylactic, not curative.

Reference: NICE CG150; ABN Headache Guidelines; BNF – Lithium