Cluster Headache vs Migraine - Difference and Comparison
Cluster headaches are rare, extremely painful and debilitating headaches that occur in groups or clusters. They often appear during seasonal changes. They are also described as suicide headaches, a reference to the excruciating pain and resulting desperation that has culminated in actual suicide.
A migraine is a form of vascular headache. Migraine headache is caused by a combination of vasodilatation (enlargement of blood vessels) and the release of chemicals from nerve fibers that coil around the blood vessels. During a migraine attack, the temporal artery enlarges. (The temporal artery is an artery that lies on the outside of the skull just under the skin of the temple.) Enlargement of the temporal artery stretches the nerves that coil around the artery and cause the nerves to release chemicals. The chemicals cause inflammation, pain, and further enlargement of the artery. The increasing enlargement of the artery magnifies the pain.
Comparison chart
 | Cluster Headache | Migraine |
|---|---|---|
| Characteristics of pain | Stabbing pain | Deep throbbing and pulsating pain |
| Location of pain | Pain located near the eye on affected side. Usually unilateral. | Deep stabbing pain around the temple or the eye. |
| Gender predominance | More common in men | More common in women |
| Sensitivity to light or sound | Rare | Typical |
| Runny nose and red, watery eyes | Present | Rare |
| Severity of pain | Very severe | Ranging from moderate to quite severe |
| Time of onset | Short; headaches peak within 45 minutes | Long; headache gradually peaks in around 4-24 hours |
| Triggers | Nitroglycerin (glyceryl trinitrate), hydrocarbons (petroleum solvents, perfume), Alcohol, napping etc. | Bright lights, loud noises, changes in sleep patterns, exposure to smoke, skipping meals etc. |
| Prodromal aura before headache | Absent | Present |
| Nausea or vomiting | Rare | Common |
| Breathing issues | breathing issues through the nostril on the side of the pain | Rare |
Signs and symptoms:
Cluster Headaches
- Deep stabbing pain around the temple or the eye which is usually unilateral.
- Stuffy or runny nose
- Tearing or redness in eyes, droopy eyelids
Migraine
- Moderate to severe, throbbing head pain.
- Most commonly one sided pain; less frequently both sides of the head are affected
- Pain located near the eye on affected side
- Pain that worsens with physical activity
- Sensitivity to light and/or sound
- Nausea or vomiting
- Debilitating pain that hinders daily activities
Pain and Other symptoms
- Pain during cluster headaches is far worse, significantly more severe than a migraine.
- Cluster headaches are frequently associated with Horner's syndrome, ptosis (drooping eyelids), conjunctival injection (which results in red, watery eyes), lacrimation (tearing), miosis (constricted pupil), eyelid edema, nasal congestion, rhinorrhea (runny nose), and sweating on the affected side of the face. The neck is often stiff or tender in association with cluster headaches afterwards, and jaw and teeth pain are sometimes reported.
- Sensitivity to light is more typical of a migraine, as is vomiting, but both can be present in some sufferers of cluster headache, although rare.
- It has been known to strike at the same time each night or morning, often at precisely the same time during the day a week later.
Prevalence
While migraines are diagnosed more often in women, cluster headaches are diagnosed more often in men. The male-to-female ratio in cluster headache ranges from 4:1 to 7:1. It primarily occurs between the ages of 20 to 50 years. Tension headaches are more common in both sexes, accounting for the vast majority of headaches.
Genetics
First-degree relatives of sufferers are more likely to have the condition than the population at large.
Triggers
Cluster Headaches
- Nitroglycerin (glyceryl trinitrate)
- Alcohol
- Hydrocarbons (petroleum solvents, perfume)
- Heat and napping may also act as a trigger.
- Significant change in sleep or work schedules, with resulting decrease in sleep and REM
Migraine
According to the National Library of Medicine's Medical Encyclopedia, Migraine attacks may be triggered by:
- Allergic reactions
- Bright lights, loud noises, and certain odors or perfumes
- Changes in sleep patterns
- Smoking or exposure to smoke
- Skipping meals
- Alcohol
- Menstrual cycle fluctuations, birth control
- Foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans), monosodium glutamate (MSG), or nitrates (like bacon, hot dogs, and salami)
- Other foods such as chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products, and fermented or pickled foods
Diagnosis
The diagnosis of migraine without aura, according to the International Headache Society, can be made according to the following criteria, the "5, 4, 3, 2, 1 criteria":
- 5 or more attacks
- 4 hours to 3 days in duration
- 2 or more of - unilateral location, pulsating quality, moderate to severe pain, aggravation by or avoidance of routine physical activity
- 1 or more accompanying symptoms - nausea and/or vomiting, photophobia, phonophobia
Treatment
For less severe migraines, over-the-counter NSAIDs, such as ibuprofen or acetaminophen, may provide sufficient relief.
Triptan drugs can provide relief for both migraine sufferers and those suffering from cluster headaches. These drugs are frequently given in the form of injections or nasal sprays. Sumatriptan and zolmitriptan are commonly prescribed; zolmitripan also comes in tablet form.
Other treatments for cluster headaches include nasal spray forms of local anesthetics (e.g., lidocaine); steroids; octreotide, which mimics a brain hormone; and dihydroergotamine, which can also be used to treat migraines. Less commonly, those with cluster headaches are prescribed oxygen for use during headaches.
Migraine sufferers may also be given opioids, like codeine. Anti-nausea drugs are commonly used as well, since many sufferers experience nausea or vomiting during a migraine.
Doctors may recommend preventive treatment for migraines and cluster headaches, particularly if one has multiple episodes over short periods of time. Preventive treatment may include lifestyle or dietary changes and will often include some form of ongoing prescription medication.
Surgery is very rarely recommended for these health problems, as there is not enough evidence yet to suggest that surgery provides relief over time.
References
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