Cyanobacterial-derived water quality impairment issues are a growing concern worldwide. In addition to their ecological impacts, these organisms are prolific producers of bioactive secondary metabolites, many of which are known human intoxicants. To date only a handful of these compounds have been thoroughly studied and their toxicological risks estimated. While there are currently no national guidelines in place to deal with this issue, it is increasingly likely that within the next several years guidelines will be implemented. The intent of this review is to survey all relevant literature pertaining to cyanobacterial harmful algal bloom secondary metabolites, to inform a discussion on how best to manage this global public health threat.