When should I consider referring a patient with cluster headaches to a specialist for further management?

Consider referral to a specialist for a first bout of cluster headache to ensure diagnosis confirmation and possible neuroimaging, especially if diagnosis is uncertain or atypical symptoms are present ¹.

Arrange specialist advice or urgent referral if red flags or a serious underlying cause of secondary headache are suspected, depending on clinical judgement ¹.

If a person has a confirmed diagnosis of cluster headache following specialist assessment, seek specialist advice if the headache does not respond to verapamil or other treatments, or if treatment during pregnancy is needed ¹.

Refer if there is diagnostic uncertainty, atypical symptoms, or refractory symptoms despite optimal primary care management ¹.