Migraine and cluster headaches

Is It a Migraine or a Cluster Headache?

The pain can be severe and debilitating whether you have a migraine or a cluster headache.

But their causes and cures are very different, making it crucial to figure out the type that’s affecting you to have the best chance at easing your pain.

Without the correct diagnosis, it’s difficult to find relief for your headache, says Merle L. Diamond, MD, associate director of the Diamond Headache Clinic in Chicago.

Signs and Symptoms

For starters, migraine and cluster headaches feel and act differently, Dr. Diamond says. People with migraines may experience nausea, sensitivity to light, and vomiting, whereas those with a cluster headache, which is generally felt on one side of the head, experience watery eyes and runny noses.

Some people who experience migraines can predict the onset because it’s preceded by an “aura,” or visual disturbances — flashing lights, zigzag lines, or a temporary loss of vision, for instance.

By contrast, cluster headaches come on suddenly, are almost always one-sided, and are accompanied by a runny nose and tearing eye on the same side of the head as the headache. For this reason, cluster headaches are often confused with sinus headaches, Diamond says, though their pain is distinct.

“Cluster headaches feel like someone put a hot poker or sword through your eye,” she says.

Although migraine headache can last from 2 to 72 hours, cluster headaches arrive and depart swiftly over a period of time.

“Cluster headaches last for shorter periods of time, but they cluster for about two weeks to three months,” Diamond says. “A cycle or cluster occurs on one side of the head, but subsequent clusters can switch sides.”

RELATED: 8 Home Remedies for Headaches and Migraines

Differences also extend to who’s more likely to get migraine or cluster headaches. Women tend to get migraines more often than men, she says, and men experience cluster headaches more often than women do.

“That’s not to say that men can’t get migraines and females don’t suffer from cluster headaches,” Diamond says. “They can, and they do.”

News of migraines is more common because they occur more frequently than cluster headaches. The National Headache Foundation reports that more than 37 million Americans suffer from migraines. Cluster headaches, however, are relatively rare, affecting about 1 million Americans, according to the American College of Physicians.

Causes of Migraines Versus Cluster

Hormones seem to play a role in causing migraine headache pain, but little is known about what causes cluster headaches.

Alcohol may trigger both types of headaches, but migraines may also be triggered by hormonal fluctuation (like what occurs with menstruation) and relaxation after stress, explains Richard Lipton, MD, a professor and vice chairman of neurology at the Albert Einstein College of Medicine and director of the Montefiore Headache Center, both in New York City. Those in the throes of a migraine prefer to retreat to dark, quiet rooms, while those who experience cluster headaches are often agitated and can’t sit still, he says.

Treatment Options

Treating both types of headaches involves the use of so-called rescue medications, usually taken at the onset of a headache, as well as preventive therapy, which aims at keeping the headaches at bay, Dr. Lipton explains.

Migraine treatment includes rescue medication such as a strong class of headache drugs called triptans and non-steroidal anti-inflammatory drugs (NSAIDs), both of which can be taken as pills. For cluster headaches, standard treatments include injectable triptans and high-flow oxygen, he says.

Fast treatment is advisable for cluster headaches, Diamond says, because the pain is so severe. “Injectables or nasal sprays work quicker than pills, the fastest treatment for a cluster headache is high-flow oxygen through a mask for about 10 minutes,” she says.

According to both Lipton and Diamond, prevention medications should be taken daily to stave off migraines. These include beta blockers (propranolol or timolol), anti-seizure drugs (topirmate), and some types of antidepressants. Cluster headache prevention may include daily doses of verapamil (a calcium channel blocker) with or without a short course of steroids.

Understanding Cluster Headache

Navigating the Symptoms & Treatments for Cluster Headaches

Cluster headache is a primary headache disorder and the most common of the group of headache disorders called trigeminal autonomic cephalalgias. The term cluster headache comes from the fact that these attacks occur in groups, or “clusters.” During a cluster cycle, brief, excruciatingly severe headache attacks recur between 1-8 times per day. Cluster cycles can last for weeks or months and are usually separated by remission periods, or periods of headache freedom, which usually last months or years. People who experience chronic cluster headache have no remission periods, or the remissions last less than a month at a time.

Cluster headache is often said to be the most painful of all headaches; it has been described as “boring,” “burning,” “like a hot poker in the eye” and as “suicide headache.”

“Cluster pain is described as being at least 10/10 in severity, and typically there is an inability to lie still,” says Dr. Deborah E. Tepper, MD, of Dartmouth University. “People with migraine tend to lie down in a dark, quiet room, while, in contrast, those with cluster will pace, rock in one place, or sometimes even bang their head to distract themselves from the pain. People almost never lie down during a cluster attack.”

Who is Affected by Cluster Headache?

The age of onset for cluster headache is most often between 20 and 40. While the condition was thought to be more common in men than in women, Eileen Brewer, vice president of Clusterbusters, says that the proportion of men and women who experience the disease has grown more even over time.

Clusterbusters is a non-profit research and educational organization dedicated to finding effective cluster headache treatments. Brewer says it is speculated that between 200,000 and 1 million people are living with cluster headache in the U.S., but that there has not been real research done on figuring out the true number.

“It’s not a rare disease,” Brewer says.

Brewer also noted that there is a perceived genetic component to the disease, but points out that there hasn’t been a great deal of research to form a proven connection.

“We have seen families that hand it down, but not everybody hands it down,” she says.

Symptoms of Cluster Headache

Cluster headache consists of severe headaches on one side of the head. It is associated with symptoms that occur on the same side of the head that the pain is taking place on, and which can include red or teary eye, runny or stuffy nostril, and flushing or sweating of the face. During attacks, some people develop a smaller pupil or a drooping eyelid on the headache side. Most cluster headache patients are restless or agitated during attacks; unlike patients with migraine, they find it hard to stay still and rarely lie down.

According to Dr. Tepper, cluster headache manifests as a searing, stabbing pain—usually behind one eye or at the temple near the forehead. Tepper notes that cluster headache attacks are shorter than migraine; they can last between 15 minutes to 3 hours.

Cluster attacks come in bouts called “periods” or “cycles,” according to Dr. Tepper. Cluster headache periods often occur 1-2 times annually and at predictable times of the year, or they can skip years.

Cluster attacks commonly occur overnight, waking people from sleep. People living with cluster headache are diagnosed as “episodic” when the attacks occur in periods lasting between 7 days and 1 year and are separated by pain-free periods lasting 1 month or longer. In “chronic” cluster headache, attacks occur for more than 1 year without remission or with remissions lasting less than 1 month.

Diagnosis of Cluster Headaches

The term “cluster headache” should be used carefully, as people will sometimes use it to refer to headaches that occur in “clusters.” The term “cluster headache” is defined by diagnostic criteria outlined by the International Headache Society.

However, Brewer says misdiagnosis is a real problem, and instead of too many people being wrongly diagnosed with cluster headache, it’s actually a matter of people not being correctly diagnosed with the disease—sometimes being misdiagnosed with a migraine disorder instead. Brewer says this issue means people sometimes wait between 5-7 years to get a proper cluster headache diagnosis.

People suspected of having cluster headache should be carefully assessed by their doctor for an underlying cause, and imaging of the brain and vessels in the head should occur. They should also be evaluated to make sure they do not have a different primary headache disorder that can mimic cluster headache.

Examples of other primary headache disorders that mimic cluster headache include:

  • migraine with prominent autonomic features
  • paroxysmal hemicrania
  • short-lasting unilateral neuralgiform headache with red eye and tearing (conjunctival injection and tearing)
  • hemicrania continua

Treatment of Cluster Headaches

Brewer says that treatment of cluster headache is still misunderstood, and that the patient community is often lumped in with migraine despite being two very different conditions.

“Even in the medical community, a lot of doctors will try to treat cluster headache with opioids, which doesn’t work at all,” Brewer says. “There’s a lot of crossover in between migraine and cluster headache treatments because there really hasn’t been a lot of research on what works for cluster headache, so a lot of people think that if you can treat a migraine, you can treat a cluster headache—and that isn’t the case at all.”

A cluster headache can be successfully treated in most cases by individualizing acute and preventive drug treatment. According to Dr. Tepper, a full treatment plan includes a temporary bridge to provide initial relief with steroids, taken either orally or injected to the back of the head, then starting a daily preventive medication such as verapamil. A full plan also includes an immediate treatment available for each attack, says Dr. Tepper.

To terminate an attack, high-flow oxygen may also be used with a face mask. Dr. Tepper says this is a very safe, highly effective for most individuals who experience cluster headache. Sumatriptan injectable, zolmitriptan nasal spray or dihydroergotamine injections, which were all originally formulated for migraine, can also help terminate an attack, Dr. Tepper says. She adds that using the pill form of any medicine to stop an individual cluster attack is not recommended, because cluster attacks reach their peak very, very quickly and last about an hour, meaning oral tablets are unable to provide adequate relief.

Newer treatment options are being explored for cluster headache, according to Dr. Tepper: a mild electrical stimulator applied to the outside of the neck at the onset of an attack (a noninvasive vagal nerve stimulator) was recently approved by the FDA, while an implanted electrical stimulator surgically placed through the upper gum (a sphenopalatine ganglion stimulator) and an injectable antibody targeting the pain chemical calcitonin gene-related peptide are in clinical trials.

Insurance, however, often limits access to any/all cluster headache treatment options. Providers must often educate both patients and insurance companies about cluster headache.

Cluster headache is an unusual, severe headache disorder with specific characteristics and treatment. As with other forms of headache, it is necessary to have an accurate diagnosis and effective treatment plan. For more information about cluster headache and how to navigate this debilitating disease, visit our resource library.

This article was last updated April 8, 2019.

Cluster Headaches

Topic Overview

What are cluster headaches?

Cluster headaches are severe headaches on one side of your head that happen in groups, or “clusters.” They usually occur over weeks or months.

Cluster headaches can be so painful that you are not able to follow your normal routine or do your usual activities. The pain is often called the worst type of headache pain.

Cluster headaches come in cycles (also called cluster periods). Most people who get cluster headaches have one or two cluster periods each year. A cluster period might last 1 month or longer. After a cluster period ends, you may not get another headache for months or even years.

As you get older, it’s likely that you’ll have longer and longer times without headaches. At some point, you may not get cluster headaches ever again.

Having cluster headaches can be scary. But even though they are very painful, cluster headaches don’t cause long-term harm. During a cycle, you may be able to reduce how often you have them, how bad they are, and how long they last.

What causes cluster headaches?

Experts aren’t sure what causes cluster headaches. They run in families, but it’s not clear why some people get cluster headaches and others don’t.

What are the symptoms?

The main symptom of cluster headaches is a severe burning or sharp, piercing pain on one side of your head. The pain spreads out from your temple and eye. Your eye may become red, watery, or puffy. The eyelid may droop, and you may have a runny or stuffy nose on that side of your head.

See a picture of cluster headache symptoms .

The pain usually gets bad very fast. The pain gets worse within 5 to 10 minutes after the headache starts and can last for 15 minutes or longer.

Cluster headaches usually happen at the same time of day each time you get them. But they can happen at any time. You may have 1 to 8 headaches a day.

How are cluster headaches diagnosed?

A doctor can usually tell if you have cluster headaches by asking about your symptoms and examining you. Your doctor may order other tests, such as a CT scan or an MRI , if he or she thinks your symptoms are caused by another disease. But most people won’t need these tests.

How are they treated during a cycle?

When a headache starts, you can take medicine or breathe in oxygen from a machine to ease the pain or stop the headache. You use these treatments only when you feel a headache coming on. You don’t use them every day.

When a cluster headache begins:

  • Start your treatment right away. Don’t wait for the headache to get worse. Take your medicine exactly as planned with your doctor.
  • Do what feels best. You may feel better if you walk, jog in place, sit, kneel, or stand. Lying down may make the pain worse.

If your treatment doesn’t work, ask your doctor if you can try something else. It may take time to find what works best for you.

Over-the-counter pain medicines, such as aspirin, acetaminophen, and ibuprofen, usually don’t work for cluster headaches.

Dealing with repeated cluster headaches can lead to stress and depression , which in turn can continue the headache cycle. Finding ways to cope with stress (such as with regular exercise) and improve depression may reduce the severity or frequency of your cluster headaches.

How are cluster headaches prevented?

There is no cure for cluster headaches. You can’t do anything to prevent a cycle of cluster headaches from starting.

But as soon as a cycle starts, you can take medicine that may help prevent more headaches or reduce how many you have during a cycle. You take this medicine every day during the cycle.

Certain things may be more likely to cause a headache during a cycle. These are called triggers. Avoiding them may help prevent headaches. Triggers include:

  • Drinking alcohol.
  • Sleep problems. It’s best if you go to bed and wake up at the same time every day. Don’t take naps.
  • Increases in body temperature. This can happen when you exercise, take a hot bath, or get angry.
  • Nitrates. These are found in wine, cured meats, aged cheeses, and some medicines.
  • Histamine. Seasonal allergies could trigger a headache.

What is the difference between a headache and a migraine?

A migraine is a type of primary headache disorder that can cause severe pain and other symptoms. People with migraine may experience recurring symptoms that doctors call episodes or attacks.

Headaches are only one symptom of migraines, and they can range in severity. Migraine can cause intense, throbbing headaches that last anywhere from a few hours to several days.

A migraine headache usually affects one side of the head, but some people experience pain on both sides.

A migraine episode can occur in four distinct phases, though not everyone experiences every phase.

Premonitory phase

Doctors also call the premonitory phase the preheadache or prodrome phase. It includes nonpainful symptoms that occur hours or days before the headache arrives.

Premonitory phase symptoms can include:

  • unexplainable mood changes
  • food cravings
  • stiffness of the neck
  • frequent yawning
  • constipation or diarrhea
  • sensitivity to light, sound, or smells

Aura phase

Auras refer to sensory disturbances that occur before or during a migraine attack. Auras can affect a person’s vision, touch, or speech.

Visual auras can cause the following symptoms in one or both eyes:

  • flashing lights
  • zig-zagging lines
  • blurred vision
  • blind spots that expand over time

Sensory auras cause numbness or tingling that starts in the arm and radiates to the face.

Motor auras affect a person’s ability to communicate and think clearly. Motor auras include:

  • slurred or jumbled speech
  • difficulty understanding what others say
  • difficulty writing words or sentences
  • having trouble thinking clearly

Headache phase

Migraine headaches can range from mild to severe. People who have a severe migraine headache may need to seek emergency medical treatment.

Physical activity and exposure to light, sound, and smells worsen the pain. People can have migraine episodes without developing a headache, however.

Postdrome phase

The postdrome phase occurs after the headache subsides. People may feel exhausted, confused, or generally unwell during the postdrome phase.

This phase can last anywhere from a few hours or several days.

Types of migraines

Migraine falls into several different categories depending on the symptoms. Some examples of migraines include:

Migraine without aura

Common migraines, or migraines without auras, cause intense, throbbing headaches on one side of the head.

These headaches usually last between 4–72 hours. Migraines without auras do not produce symptoms before the onset of the migraine attack, but people with this type of migraine may have the premonitory symptoms described above.

Migraine with aura

According to the National Institute of Neurological Disorders and Stroke, about one in every three individuals with migraine reports experiencing an aura before the headache.

People who have migraine episodes with auras might not experience an aura every time. Headaches may or may not accompany auras.

Abdominal migraine

According to the authors of a 2018 article, abdominal migraines usually affect children between the ages of 3 and 10 years old.

Abdominal migraines cause abdominal pain, nausea, and vomiting. People who have this type of migraine can develop a mild headache or no headache at all.

Hemiplegic migraine

This rare type of migraine causes temporary paralysis before or during the headache. Other symptoms of hemiplegic migraines include:

  • vertigo (dizziness)
  • a piercing or stabbing sensation in the head
  • vision problems
  • difficulty speaking or swallowing
  • trouble moving one side of the body

Risk factors for migraine

Researchers and doctors have identified several factors associated with higher risks of migraines. These include:

  • being female
  • having a family history of migraines
  • mood disorders, such as depression, anxiety, or bipolar disorders
  • sleep disorders

Trial Mix

I received a phone call re “cluster” headaches, I told about my last two headaches. One was a short intense pain on the right side of my head which started when i woke up. Almost all my headaches are on the right side. The other headache started on a Sunday evening and ended on a Thursday. That headache was cyclical, that is, the pain swelled, disappeared, returned in a different form. I was told I was not a good fit. Yet, Tonight I even have a different type of pain. it’s a band across the top of my head, and I’ve been pretty woozy.
Almost more like a ‘hangover’ headache. And it seems like it is moving to the left temple. I have had headaches over the past 58 years, They have made me very sick. This is the second time in my life I have had such debilitating problems. I’ve had every headache you describe. and one which was diagnosed (by me) as a tic dolereaux. Crossing the street in Tulsa, the pain hit so hard so fact it literally knocked me down in the street. The headache did not leave for a couple of days, and the depression that followed was deep. TMI….Headaches are no longer tens but are at an 8 to a 9 level.
I’d really like to have some research on my headaches.

Cluster Headaches

Dr. Papay & Dr. Tepper headache research.

Cluster headaches are the most severe headaches. A cluster headache can be many times more intense than a migraine attack. It has been called the “suicide headache” because some people have taken their lives either during an attack or in anticipation of an attack.

The term “cluster headache” refers to headaches that have a characteristic grouping of attacks. Cluster headaches occur up to eight times per day during a cluster period, which may last 2 weeks to 3 months, or longer. The headaches may disappear completely (go into “remission”) for months or years, only to recur at a later date. A cluster headache typically awakens a person from sleep 1 to 2 hours after going to bed. These nocturnal attacks can be more severe than the daytime attacks.

Who is affected by cluster headaches?

Cluster headaches are an uncommon type of primary headaches (i.e., a headache that has no structural cause), affecting less than 1 in 1,000 people. Cluster headaches are a young person’s disease, and the headaches typically start before age 30. Cluster headaches are more common in men, but more women are starting to be diagnosed with this disorder. The male-to-female gender headaches appear to be six times more common in men than women, especially men in their 20s or 30s.

The true biochemical cause of cluster headaches is unknown. However, the headaches occur when a trigeminal-autonomic reflex pathway in the brainstem is activated. The trigeminal nerve is the chief sensory nerve of the face. When activated, the trigeminal nerve leads to the eye pain associated with cluster headaches. The trigeminal nerve also stimulates the parasympathetic autonomic system, which causes the eye tearing and redness, nasal congestion and discharge with cluster attacks. Cluster headaches appear to be generated by the hypothalamus (the part of the brain that is home to the suprachiasmatic nucleus or circadian clock). Recent imaging studies have shown activation or stimulation of the hypothalamus during a cluster attack.

Cluster headaches usually are not caused by an underlying condition such as a tumor or aneurysm. Thus, they are considered to be a form of ‘primary’ headache.

What triggers cluster headaches?

The season is the most common trigger for cluster headaches, which often occur in the spring or autumn. Due to their seasonal nature, cluster headaches are often mistakenly associated with allergies or sinusitis. The seasonal nature of cluster headaches most likely results from stimulation or activation of the hypothalamus.

Cluster headaches are also common in people who smoke and drink alcohol frequently and a large proportion of the patients have sleep apnea.

During a cluster period, the sufferer is more sensitive to the action of alcohol and nicotine, and minimal amounts of alcohol can trigger the headaches. During headache-free periods, the patient can consume alcohol without provoking a headache.

Smoking can also increase the severity of cluster headaches during a cluster period.

What are the symptoms of a cluster headache?

Cluster headaches generally reach their full force within five or ten minutes after onset. The attacks are usually very similar, varying only slightly from one attack to another.

Type of pain

The pain of cluster headache is one-sided, and during a headache period, the pain remains on the same side. When a new headache period starts, it rarely occurs on the opposite side.

Severity/intensity of pain

The pain of cluster headache is generally very intense and severe and is often described as having a burning or piercing quality. It may be throbbing or constant. The pain is so intense that most cluster headache sufferers cannot sit still and will often pace during an attack.

Location of pain

The pain is located behind one eye or in the eye region, without changing sides. It may radiate to the forehead, temple, nose, cheek, or upper gum on the affected side.

The scalp may be tender, and the pulsing in the arteries often can be felt.

Duration of pain

The pain of a cluster headache can last anywhere from 15 minutes to three hours. In general, the headaches last for 30 to 90 minutes. The headache will disappear only to recur later that day. Typically, in between attacks, people with cluster headaches are headache free but the pain can sometimes linger.

Frequency of headaches

Most sufferers get one to three headaches per day during a cluster period (the time when the headache sufferer is experiencing daily attacks). They occur very regularly, generally at the same time each day, and they often awaken the person at the same time during the night.

The cluster periods can last from two weeks to three months and then disappear completely for months or years. The episodic cluster headache sufferer has variable pain-free intervals between headache attacks.

Attacks appear to be linked to the circadian (or “biological”) clock. Most people with cluster headaches will develop cluster periods at the same time each year — either in the spring or fall or the winter or summer.

Most cluster sufferers (80% to 90%) have episodic cluster headaches that occur in periods lasting seven days to one year, separated by pain-free episodes lasting 30 days or more.

In about 20% of people with cluster headaches, the attacks may be chronic. Some patients will note that the series of headaches are not separated by periods of remission lasting longer than a month. These cases are chronic.

What are the warning signs of a cluster headache?

Although the pain of a cluster headache starts suddenly, a minimal type of warning of the oncoming headache may occur, including a feeling of discomfort or a mild one-sided burning sensation.

What are some associated symptoms of a cluster headache?

The affected eye may become swollen or droop. The pupil of the eye may get smaller and the conjunctiva (the tissue that lines the inside of the eyelid) will redden. There may be nasal discharge or congestion and tearing of the eye during an attack, which occur on the same side as the pain.

Excessive sweating may occur, and the face may become flushed on the affected side. Cluster headaches are not typically associated with the nausea or vomiting. People with cluster headaches appear to develop as much sensitivity to light that are found in other types of headaches, such as migraine and sound as people who have migraines.

It is possible for someone with cluster headaches to also suffer from migraines.

People who suffer from cluster headaches–especially people who have tooth or cheek pain with the cluster attacks–have an increased risk of developing a stomach ulcer.

Researchers believe that histamines, which dilate or expand blood vessels, influence the onset of a cluster headache because during a cluster headache, the level of histamine increases in a person’s blood and urine.

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The Differences Between Migraines and Cluster Headaches

Migraines and cluster headaches are two conditions that can cause severe head pain. But beyond that, there are very few similarities. The only other things the two conditions often have in common are that both generally involved one-sided pain and that congestion can be a symptom. Here are some of the biggest differences between the two and a natural way to find relief from both migraines and headaches.

5 Contrasts Between Migraines and Cluster Headaches

Here 5 of the primary differences:

  • Migraines can last for hours or even days at a time. Cluster headaches last from just minutes to a few hours, but the pain is more severe and multiple headaches occur in one day.
  • Migraines have a gradual onset – you may even have symptoms a day in advance. Cluster headaches go from zero pain to full intensity in under 10 minutes.
  • Women who get migraines outnumber men by about three to one. Cluster headaches are more common in men.
  • Migraines are very common and affect about 12% of adults. Cluster headaches are rare and affect less than one-third of one percent of people.
  • Migraines often present with nausea and sensory sensitivity. Cluster headache symptoms include a watery, red eye on the affected side along with a drooping or swollen eyelid.

Now that you can identify the difference between these two conditions, is there a way to find relief from the pain without reaching for a bottle of pills?

Drug-Free Migraine and Headache Relief

Upper cervical chiropractic care has been helping many migraine and headache patients in case studies. This is because many of these conditions go back to a misalignment of the atlas (C1) or axis (C2) vertebrae. Such a misalignment can affect blood flow to the brain, cerebrospinal fluid drainage, brainstem function, and many other factors that are related to head pain and other symptoms.

If you’ve experienced head or neck trauma in the past, you are more likely to have a subluxation in the C1 or C2. However, even if you don’t remember such an injury, it is worth having an examination if you are dealing with a chronic headache condition. You may be a gentle adjustment away from finding natural relief.

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