Cluster Headaches: The Daily PANCE Blueprint
A 48-year-old male wakes up with intense, stabbing pain behind his right eye. He also has some facial flushing and nasal discharge. Which of the following is the best long-term prophylactic treatment of choice for the most likely diagnosis?
A. Amitriptyline
B. Sumatriptan
C. Verapamil
D. Gabapentin
E. Topiramate
Answer and topic summary
The answer is C. Verapamil
A cluster headache is a rare type of headache (typically unilateral) that usually occurs in middle-aged men. It is characterized by an unique, excruciating periorbital pain. Other clinical features of the headache may include: flushing, nasal congestion, lacrimation (in one eye). It can get worse with alcohol and may even wake patients up in the middle of the night. First line treatment is sumatriptan and oxygen. Prophylactic treatment of choice is verapamil daily.
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