MRCP revision battle 8.1: Cluster headache

Its Saturday and sunny so I'm not particularly feeling the MRCP revision love.  But the battle must continue, and today's topics are:

Revision battle 8.1: Cluster headache
Revision battle 8.2: Arsenic poisoning
Revision battle 8.3: Mee's lines
Revision battle 8.4: Reversible causes of cardiac arrest
Revision battle 8.5 Pituitary tumours
Revision battle 8.6: Romano-Ward and Jervell-Lange-Nielson



Revision battle 8.1: Cluster headache


Cluster headaches appear in the MRCP exam (and occasionally real life) as:

• severe unilateral pain focused around one eye with
• redness of the eye and possibly
• lid swelling with
• lacrimation and
• nasal congestion

It is worth noting that up to 20% will also get ptosis, which in a minority of cases can be permanent.


Cluster headaches are more common in males (5:1).
Risk of suffering from cluster headache is increased if you are a smoker.


Classically patients will suffer from severe 15 minute to 2 hour bouts of pain once or twice a day over a period of 4 to 12 weeks.


Treatment acutely is 100% oxygen.  S/C sumitriptan and nasal lidocaine are also proposed as treatments.

Prophylactic options include verapamil, prednisolone or lithium.


So onwards to a slightly curveball topic - arsenic poisoning...