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Background Acute trigeminal autonomic cephalalgia (TAC) headache service is a rapid access consultation service for patients with TAC headaches offering urgent advice and treatment. We aimed to evaluate the effectiveness of this service.Methods Data from successive consultations ( n=419) in the acute TAC headache service from 19/02/2018 to 29/07/2024 were collected from clinic letters as part of a service evaluation. Data were summarized as percentages or as medians with interquartile ranges.Results Data from 419 consultations of 190 patients were analyzed. Their median age was 49 years (IQR: 38-58) and 67% were male. The highest number of referrals were received in March (11.5%) and November (9.8%) and 19% were for patients new to the service. The majority had cluster headache (79%), followed by other primary headaches (20%) and secondary headaches (1%).Interventions included treatment revisions (51%), greater occipital nerve (GON) injections (13%), a combination of GON injection and treatment revisions (24%) or advice alone (11%). Interventions were effective in 62% of the reviews.Conclusion An acute TAC headache service is an effective service for patients with primary headache disorders, especially for cluster headache, which can provide urgent support during bouts of headache minimizing the need to visit the emergency department.pubuduamarasena07@gmail.com