But because the treatments for the two diseases are very different, it’s crucial to figure out which you have — or whether you have something else entirely — 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. Here’s what you need to know about the symptoms, causes, and treatment options for these two different types of headaches.
Signs and Symptoms
There can be some similarities between migraine attacks and cluster headaches, says Kiran Rajneesh, MBBS, who specializes in neurology and pain medicine at The Ohio State University Wexner Medical Center in Columbus. “They are both headaches, they both can be unilateral (one-sided), and both can involve the forehead,” Dr. Rajneesh says. Despite those similarities, there are many ways to distinguish between the two. Migraine attacks and cluster headaches feel and act differently, according to Dr. Diamond. People with a migraine attack may experience nausea, sensitivity to light, and vomiting, whereas those with a cluster headache experience watery eyes and runny noses, she says. Some people who experience migraine attacks can predict the onset because it’s preceded by an aura, usually in the form of visual disturbances — such as flashing lights, zigzag lines, or a temporary loss of vision, according to the American Migraine Foundation. By contrast, cluster headaches occur suddenly, almost always cause symptoms on one side of the head, 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. Whereas the cluster headache is associated with a piercing and very intense pain, the pain of a migraine attack is usually described as a pulsing sensation or throbbing pain, and it’s usually moderate in intensity, rarely severe, says Rajneesh. People also tend to respond to migraine attacks and cluster headaches differently. To ease migraine pain and other symptoms, people often find relief by resting in a quiet, dark room, according to Medline Plus. In contrast, most people with cluster headaches pace and can sometimes exhibit aggressive behavior, says Rajneesh. “Because the pain of a cluster headache is so severe, patients can become very agitated and restless,” he says.
Could a Headache Caused by COVID-19 Be Mistaken for a Cluster Headache or Migraine Attack?
Headache is one of the most commonly reported symptoms of COVID-19, the viral illness caused by SARS-CoV-2, according to the Centers for Disease Control and Prevention (CDC). The Journal of Headache Pain published a survey in October 2020 that looked at the characteristics of headaches that occurred as a result of COVID-19. People reported having headaches in which the pain was pulsating, pressing, and even stabbing. The survey reported that men were more likely than women to have COVID-19-related headaches. The headaches were reported to be bilateral (on both sides of the head), often lasted longer than 72 hours, and commonly occurred along with gastrointestinal symptoms and loss of taste and smell. If you have sudden onset of a headache and neck pain, especially if it is accompanied by fever and malaise, it could be caused by an underlying viral infection, including COVID-19, says Rajneesh. If you experience a sudden headache and you suspect it may be COVID-19-related, contact your healthcare provider right away. RELATED: From Nose to Toes, the List of COVID-19 Symptoms Keeps Growing
Do Migraine Attacks Last Longer or Happen More Frequently Than Cluster Headaches?
A migraine attack typically lasts between 4 and 72 hours, says Rajneesh. That’s longer than a cluster headache lasts, which is between 15 minutes and three hours. Most people with migraine have one or two migraine attacks per month, but some people have them much more frequently. About 1 percent of the population has chronic migraine, which is defined as having at least 15 migraine days per month, according to American Migraine Foundation. Cluster headaches come in bouts, or “cluster periods.” These periods last for weeks or months, according to the International Headache Society, and are separated by remissions lasting months or years. During a cluster period, the frequency of headaches ranges from one every other day to as many as eight per day.
Migraine More Common Than Cluster Headache
More people have likely heard of migraine than of cluster headaches because migraine is much more common. The National Headache Foundation reports that more than 37 million Americans have migraine. According to the Migraine Research Foundation, migraine is the third most prevalent illness in the world. Cluster headaches, on the other hand, are rarer, affecting between an estimated 200,000 and one million Americans, according to Eileen Brewer, president of the patient advocacy group Clusterbusters, speaking to the American Migraine Foundation.
Gender a Risk Factor in Migraine and Cluster Headaches
More women have migraine than men, says Diamond, and more men have cluster headaches than women. About 3 out of 4 people with migraine are women, according to the Migraine Research Foundation. Indeed, most pain conditions, including back pain, neck pain, migraine, and most headaches are more common in women than in men, according Rajneesh. “We really don’t understand why,” he adds. “Cluster headache is one of the rare exceptions where men are more affected than women. The ratio is pretty high — it’s about 4 to 1, men to women,” says Rajneesh.
Both Migraine and Cluster Headache Can Get Better With Age
Puberty is often the time when girls first have migraine attacks, and they’re most common between ages 18 and 44, according to Migraine Research Foundation. About 2 out of 3 women with migraine will have significant improvement in their migraine attack frequency when they go through natural menopause, especially for women who have migraine with aura, according to American Migraine Foundation. The average age of onset of cluster headache is between 20 and 40, according to American Migraine Foundation. People may not “age out” of cluster headaches entirely, but the amount of time between bouts of cluster headaches usually increases, leading to fewer headaches, according to the Migraine Trust.
Causes and Triggers of Migraine Versus Cluster Headaches
Genetics play a significant role in migraine. If one or both of a person’s parents have migraine, there’s a 50 to 75 percent chance that they will, too, according to the American Migraine Foundation. Genetics are believed to less strongly influence the occurrence of cluster headaches but are suspected to be involved in about 10 percent of people with cluster headache, according to the National Organization for Rare Disorders (NORD). The underlying cause of cluster headache is not known. The direct cause of pain is thought to be a result of blood vessels dilatating and creating pressure on the trigeminal nerve, says NORD. Alcohol may trigger both types of headaches, but migraine attacks may also be triggered by hormonal fluctuation (like what occurs with menstruation) and relaxation after stress, says 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. RELATED: 7 Top Remedies for Menstrual Migraine
Treatment Options for Migraine and Cluster Headache
Treating both cluster headache and migraine involves the use of so-called rescue medications, usually taken at the onset of symptoms, as well as preventive therapy, which aims at keeping the headaches or attacks at bay, Dr. Lipton says.
Rescue Treatments for Quick Relief
Migraine rescue medications that have been used for years include a class of drugs called triptans, as well as nonsteroidal anti-inflammatory drugs (NSAIDs). Two newer classes of medications approved to treat acute migraine are gepants and ditans. Gepants are unique in that they are not associated with medication-overuse headache, a kind of headache that can occur when people overuse acute migraine medications, according to the American Migraine Foundation. For cluster headaches, standard treatments include injectable triptans and high-flow oxygen, says Lipton. Fast treatment is advisable for cluster headaches, Diamond says, because the pain is so severe. “Injectables or nasal sprays work quicker than pills, [but] the fastest treatment for a cluster headache is high-flow oxygen through a mask for about 10 minutes,” she says. “Nerve blocks can also be used to treat cluster headaches,” says Rajneesh. These in-office procedures, in which a numbing agent, or anesthetic, is injected into the scalp near particular nerves, can improve cluster headaches for a few weeks to a few months, he adds. RELATED: How to Get Rid of a Headache or Migraine Attack Fast
Preventive Treatments
According to both Lipton and Diamond, if migraine attacks occur regularly, preventive medications should be taken daily to stave them off. These include beta blockers (propranolol or timolol), anti-seizure drugs such as Topamax (topiramate), and some types of antidepressants. Some forms of birth control pills can help improve migraine in women, though for some women the pills can increase the risk of stroke or heart disease, according to the American Migraine Foundation. Cluster headache prevention may include daily doses of verapamil (a calcium channel blocker), with or without a short course of steroids. Whether a person has migraine or cluster headaches, it’s important to see a healthcare professional for treatment, says Rajneesh. “Managing pain in cluster or migraine not only gives the person pain relief, but it can also restore a sense of normalcy from these severe headaches so that a person can enjoy their family, jobs, and hobbies more fully,” he says. Additional reporting by Becky Upham.
