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Cluster Headache — RACP Adult Medicine MCQ

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ModerateNeurologyCluster HeadacheRACP Adult Medicine

A 45-year-old man presents with severe unilateral periorbital headache lasting 45 minutes, occurring 3 times daily for 6 weeks. It is associated with ipsilateral lacrimation, conjunctival injection, nasal congestion, and ptosis. He is restless and pacing during attacks. What is the most appropriate acute treatment?

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Correct answer: B — Continue sumatriptan PRN

Strictly unilateral periorbital pain with autonomic features (lacrimation, conjunctival injection, nasal congestion, Horner syndrome) and restlessness is cluster headache. Acute treatment is subcutaneous sumatriptan 6 mg or high-flow oxygen (100%, 12 L/min via non-rebreather for 15–20 minutes). Preventive treatment is verapamil (requiring ECG monitoring for heart block).

Reference: eTG Neurology – 2024 – Cluster Headache; EHF 2024