What features characterize cluster headache, and what is first-line acute treatment?

What features characterize cluster headache, and what is first-line acute treatment?

• A. Severe bilateral throbbing pain with photophobia; treat with NSAIDs.
• B. Mild unilateral headache with aura.
• C. Chronic daily headaches with no autonomic features.
• D. Severe unilateral periorbital pain with autonomic features; high-flow oxygen and subcutaneous sumatriptan.

Answer: (D)

Cluster headache shows up as severe unilateral periorbital (or temple) pain on one side, accompanied by autonomic features on the same side such as tearing, conjunctival injection, nasal congestion or rhinorrhea, and ptosis or miosis. The attacks are brief but extremely intense and occur in clusters over weeks to months, with remission periods in between. This pattern—horrific unilateral orbital pain with ipsilateral autonomic symptoms and a distinct cluster-and-remission course—helps distinguish it from migraines or tension-type headaches, which typically lack those prominent autonomic signs and have different timing and relief patterns. For immediate relief, the first-line acute treatments are high-flow 100% oxygen and a triptan. Deliver 100% oxygen at a high flow rate (around 12–15 L/min) with a nonrebreather mask for about 15–30 minutes; many patients experience rapid improvement. If oxygen alone isn’t enough or isn’t available, a subcutaneous dose of sumatriptan (6 mg) is a highly effective abortive option, with intranasal sumatriptan or zolmitriptan as alternatives when injections aren’t feasible. NSAIDs do not provide reliable acute relief for cluster headaches, which is why they’re not considered first-line in this setting.

Cluster headache shows up as severe unilateral periorbital (or temple) pain on one side, accompanied by autonomic features on the same side such as tearing, conjunctival injection, nasal congestion or rhinorrhea, and ptosis or miosis. The attacks are brief but extremely intense and occur in clusters over weeks to months, with remission periods in between. This pattern—horrific unilateral orbital pain with ipsilateral autonomic symptoms and a distinct cluster-and-remission course—helps distinguish it from migraines or tension-type headaches, which typically lack those prominent autonomic signs and have different timing and relief patterns.

For immediate relief, the first-line acute treatments are high-flow 100% oxygen and a triptan. Deliver 100% oxygen at a high flow rate (around 12–15 L/min) with a nonrebreather mask for about 15–30 minutes; many patients experience rapid improvement. If oxygen alone isn’t enough or isn’t available, a subcutaneous dose of sumatriptan (6 mg) is a highly effective abortive option, with intranasal sumatriptan or zolmitriptan as alternatives when injections aren’t feasible. NSAIDs do not provide reliable acute relief for cluster headaches, which is why they’re not considered first-line in this setting.