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

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

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 .

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

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 .

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

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