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Cluster headache — SCE Neurology MCQ

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HardHeadacheCluster headacheSCE Neurology

A 45-year-old man has excruciating right orbital pain lasting 45 minutes, occurring twice nightly for 3 weeks. During attacks his right eye waters and the nostril blocks. He paces the room and cannot lie still. Neurological examination is normal between attacks. What is the most appropriate management?

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Correct answer: B — Cluster headache requiring high-flow oxygen and a rapid-acting triptan

The best answer is “Cluster headache requiring high-flow oxygen and a rapid-acting triptan”. Primary headache diagnosis follows attack phenotype and absence of secondary red flags; acute and preventive treatment is selected by headache type, frequency, disability and contraindications. The alternatives “Oral paracetamol taken after each prolonged nocturnal attack”, “Indomethacin as a diagnostic and acute treatment trial”, “Oral sumatriptan because slow absorption matches attack duration”, “Long-term opioid therapy for recurrent cluster periods” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: NICE CG150 headache recommendations: https://www.nice.org.uk/guidance/cg150/chapter/Recommendations