What is migraine or a cluster headache?

Although migraines and cluster headaches both cause severe pain in the head around the forehead, temples or sinuses, they typically feel and act differently.

A migraine is severe pain or throbbing, typically on one side of the head.

Cluster headaches are painful headaches that are shorter in duration but recur over a period of a few months and are followed by a period of remission up to a few years. People who suffer from cluster headaches tend to get them during the same season each year.

A migraine is a common condition that affects more than 37 million Americans, while cluster headaches are rarer and only affect approximately 1 million people.

Epilepsy

Causes of migraines or cluster headaches

The cause of migraine appears to be linked to hormones, genetics or environmental factors, while the cause of cluster headaches is not fully understood. Research has linked cluster headaches to a nerve in the face that causes intense pressure around one of the eyes.

Triggers for migraines

  • Alcohol use
  • Relaxing after a stressful situation
  • Hormone changes
  • Food or food additives
  • Stress
  • Medications
  • Intense physical activity or exertion
  • Sensory or light stimuli

Cluster headaches typically recur in certain seasons, so they are often mistaken for seasonal allergies.

Risk factors for migraines or cluster headaches

Risk factors vary depending on if it is a cluster headache or migraine.

Migraine risk factors

  • Age — migraines seem to start in adolescence and peak in a person’s 30s
  • Gender — women are three times more likely to suffer from migraines
  • Family history — if a family member suffers from migraines, you are also at higher risk of developing them
  • Hormonal changes — some women experience migraines right before menstruation when hormone levels are high

Cluster headache risk factors

  • Gender — men are more likely to suffer from cluster headaches
  • Age — most people develop cluster headaches between 20 and 50 years old
  • Smoking — if you are a smoker, you are more likely to suffer from cluster headaches

Symptoms of migraines or cluster headaches

Symptoms differ based on whether you have a cluster headache or migraine.

Symptoms of migraines

  • Nausea
  • Light sensitivity
  • Vomiting
  • Temporary loss of vision
  • Symptoms can last up to 72 hours

Symptoms of cluster headaches

  • Severe pain on one side of the head
  • Sudden onset of pain
  • Watery eyes
  • Runny nose
  • Symptoms are shorter in duration than migraines but can recur frequently over a period of a few months
  • Wakes you up in the middle of the night

Diagnosis of migraines or cluster headaches

A neurologist typically will diagnose your migraine or cluster headaches during a physical and neurological exam. During the exam, he or she will take a full medical and family history, evaluate your symptoms, and order other tests to confirm your diagnosis.

Testing may include:

  • Blood tests — blood tests can rule out infections or toxins in the blood stream that are causing your symptoms.
  • Imaging — MRI and CT scans can take detailed images of the brain to determine if you have other conditions such as a brain tumor that is causing your symptoms.
  • Spinal tap (lumbar puncture) — a spinal tap may be performed to rule out an infection in the brain.

Treatment for migraines or cluster headaches

Because there is not a cure for migraines or cluster headaches, the goal of treatment is to prevent the attacks as well as decrease the severity of symptoms. Specific treatments will vary based on the type of headache.

Migraine treatments include:

Medications that relieve pain
Pain relief medications should be taken when an attack comes on to reduce the pain associated with the migraine. Mild migraines may be handled with OTC aspirin or ibuprofen, while severe migraines may need prescription medication. Other medications that may be used to relieve pain include Triptans, Ergots, Anti-nausea medication, pain medication and glucocorticoids.

Medications that prevent future attacks
Preventive medications are taken daily and can reduce the number or severity of migraines. Not all patients are candidates for prevention medication. Preventive medication is best for patients who are not finding symptoms relief on pain relief medications, who have four or more migraines a month, and have attacks that last longer than 12 hours. Common medications that are used to prevent migraine attacks include cardiovascular drugs, antidepressants, anti-seizure drugs, pain relievers or Botox.

Your doctor will determine the most appropriate medication for your case, taking into consideration your symptom severity, overall health and other medical conditions.

Cluster headache treatment needs to be fast-acting. Treatments include:

  • Pure oxygen treatment
  • Triptans
  • Octreotide
  • Local anesthetics
  • Dihydroergotamine

Preventive treatments for cluster headaches can be recommended based on your case. Your doctor will determine treatment that is most effective for you.

Preventive treatments for cluster headaches include:

  • Calcium channel blockers
  • Corticosteroids
  • Lithium carbonate
  • Nerve block
  • Melatonin

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