Neurology: cluster headache: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Neurology: cluster headache

Sample item

A 35-year-old smoker has had severe unilateral orbital pain lasting 45 minutes, occurring several times daily at about the same time for three weeks, with lacrimation, nasal congestion and ptosis on the same side. He paces the room during attacks. What is the most appropriate acute treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. High-flow 100% oxygen by non-rebreather mask

Cluster headache is a trigeminal autonomic cephalalgia with short, excruciating periorbital attacks with ipsilateral autonomic features and restlessness. High-flow oxygen at 12 to 15 L/min for 15 minutes aborts attacks in most patients, as does subcutaneous sumatriptan. Verapamil is the preferred preventive drug.

Option by option

  • A. High-flow 100% oxygen by non-rebreather mask (correct)

    Correct. High-flow oxygen is a safe, effective first-line abortive treatment.

  • B. Oral sumatriptan tablet

    Oral triptans are absorbed too slowly for attacks that peak in minutes, unlike the subcutaneous route.

  • C. Oral paracetamol

    Simple analgesics act too slowly and are ineffective for such severe pain.

  • D. Oral ibuprofen

    Oral NSAIDs have a slow onset and are ineffective for cluster attacks.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, High-flow 100% oxygen by non-rebreather mask. Cluster headache is a trigeminal autonomic cephalalgia with short, excruciating periorbital attacks with ipsilateral autonomic features and restlessness.

Why is "Oral sumatriptan tablet" not the answer?

Oral triptans are absorbed too slowly for attacks that peak in minutes, unlike the subcutaneous route.

Why is "Oral paracetamol" not the answer?

Simple analgesics act too slowly and are ineffective for such severe pain.

Why is "Oral ibuprofen" not the answer?

Oral NSAIDs have a slow onset and are ineffective for cluster attacks.

What concept does this question test?

It tests Neurology: cluster headache in General Medicine. High-flow oxygen at 12 to 15 L/min for 15 minutes aborts attacks in most patients, as does subcutaneous sumatriptan. Verapamil is the preferred preventive drug.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neurology: cluster headache?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.