Cluster Headache — RACP Adult Medicine MCQ

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EasyNeurologyCluster HeadacheRACP Adult Medicine

A 50-year-old man presents with episodic severe unilateral periorbital pain lasting 45–90 minutes, occurring 3–4 times daily for the past 2 weeks. During attacks he has ipsilateral lacrimation, conjunctival injection, and nasal congestion. He paces restlessly during episodes. What is the diagnosis?

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Correct answer: B — Cluster headache

Cluster headache presents with strictly unilateral, severe periorbital/temporal pain lasting 15–180 minutes, occurring 1–8 times daily in clusters of weeks to months. Ipsilateral autonomic features (lacrimation, conjunctival injection, nasal congestion/rhinorrhoea, miosis/ptosis) are characteristic. Restlessness/agitation during attacks distinguishes cluster from migraine (where patients prefer to lie still). Acute treatment is high-flow oxygen (12–15 L/min via non-rebreather for 15 minutes) and/or subcutaneous sumatriptan 6 mg. Verapamil is first-line prophylaxis.

Reference: eTG – 2025 – Neurology; EHF – 2023 – Cluster Headache Guidelines