A 38-year-old woman presents with unilateral periorbital headache lasting 45 minutes, occurring in clusters of 3-4 episodes per day for the past 3 weeks, accompanied by ipsilateral lacrimation and nasal congestion. Which is the most effective acute abortive treatment?
- A Oral sumatriptan
- B Oral indomethacin
- C Subcutaneous sumatriptan ✓
- D IV methylprednisolone
Correct answer: C. Subcutaneous sumatriptan
Explanation
Cluster headache is characterized by severe unilateral periorbital pain with autonomic features, occurring in bouts. Acute treatment is high-flow oxygen or subcutaneous sumatriptan (rapid onset). Oral triptans have delayed absorption and are less effective for cluster. Indomethacin is for paroxysmal hemicrania. Steroids are used for prophylaxis, not acute attacks.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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