Cluster Headaches

  • May be evidence during acute attack of autonomic signs symptoms such as:
    • ipsilateral lacrimation
    • rhinorrhoea
    • partial horners syndromme


  • Sub cut sumatriptan is treatment of choice in acute attack
  • Nasal spray second choice – less effective but useful for people who can’t tolerate subcut route

Oral triptans are ineffective


Verapamil (A CCB) is unlicensed but is treatment of choice for episodic and chronic cluster headache


Most patients will be reffered to specialist for confirmation as even a normal CT head can’t completely rule out an anatomical lesion.