Headache is the most common symptom reported in general practice; the lifetime prevalence is over 90%.1 Furthermore, 4.4% of patients see a primary care clinician about a headache every year, of whom 4% are referred to secondary care.2 Many causes of headache are self-limiting and can be managed with over-the-counter care, but some can be excruciatingly painful (the pain of cluster headaches has been compared to other very severe pains, such as childbirth), or associated with significant morbidity and mortality.

The new RCGP eLearning course on migraine and cluster headaches aims to improve knowledge in these areas, using a case-based approach to answer some of the following common clinical questions.

Cluster headache is part of the group of trigeminal autonomic cephalgias, which all have associated autonomic symptoms and are extremely painful. A patient with cluster headache will be very distressed. The headache will be unilateral, with ipsilateral symptoms such as a watering eye or nose, pupil constriction, sweating, and eyelid swelling. The patient may be agitated and unable to sit still, and they may have had a similar headache in the past, usually lasting up to 3 hours.3

A GP should be able to recognise and treat cluster headache, but should then refer to neurology (ideally on an urgent pathway) for confirmation of the diagnosis, exclusion of differentials, and consideration of prophylactic treatment …