Intended for healthcare professionals

Rapid response to:

Primary Care 10-minute consultation


BMJ 2005; 330 doi: (Published 10 February 2005) Cite this as: BMJ 2005;330:346

Rapid Response:

Oh what a headache!

The new article in the 10 minute conultation series is welomed and helpful. I have one objection: the advice to refer all patients with cluster headache to a neurologist is overly cautious. Cluster headache is diagnosed from the history; the examination is usually normal. Treatment in a GP setting where oxygen is not readily available for this condition warrants greater attention to the tryptans, such as sumatriptan, which are readily available. Prophylaxis with indomthacin is, in my opinion safer than valproate or lithium. A good website for further information on this matter is Cluster

Competing interests: None declared

Competing interests: No competing interests

11 February 2005
David M Lewis
General Practitioner
Watford, UK WD24 7PH