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Cluster Headache Acute Treatment — FRCA Final MCQ

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ModeratePain MedicineCluster Headache Acute TreatmentFRCA Final

A 45-year-old man with cluster headache is referred to the pain clinic. He has 4-6 attacks per day lasting 45-90 minutes each. The headaches are strictly unilateral with lacrimation and nasal congestion. First-line acute treatment according to NICE CG150 is:

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Correct answer: E — Subcutaneous sumatriptan 6 mg AND/OR high-flow 100% oxygen at 12 L/min via a non-rebreather mask for 15 minutes

NICE CG150 recommends subcutaneous sumatriptan 6 mg (fastest onset, most effective) AND/OR 100% oxygen at 12-15 L/min via a non-rebreather mask for 15-20 minutes as acute treatment for cluster headache attacks. Oral triptans are too slow in onset for cluster attacks (which peak rapidly). Oxygen is the preferred first-line as it has no drug side effects and can be used repeatedly. For prophylaxis: verapamil (first-line), lithium, or greater occipital nerve block. Cluster headache is sometimes called 'suicide headache' due to the severity of pain.

Reference: NICE – 2021 – CG150 Headaches; Faculty of Pain Medicine – 2021 – Headache management