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.”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 are 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.
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 rescue medication includes 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, [but] 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.