Cluster or Migraine: What’s the Difference?

Spending a bit of time on Twitter lately, I’ve noticed that there still seems to be quite a bit of confusion over what migraine is, as opposed to what cluster is.

Sometimes in the past the two have been used interchangeably.  Or sometimes, just based on imprecise information.  For example, sometimes people think of any bad headache as a "migraine headache", or think of certain types of pain as a "cluster headache".

In reality, these two are very different, and require different types of treatment.  Let’s take a quick look at cluster and migraine, and see if we can clear up a few misconceptions.

Migraine vs Cluster
Migraine
Cluster

Similar

  • Typically one-sided pain
  • Congestion a common symptom

Different

  • Pain usually moderate to severe
  • Usually a throbbing pain (if headache is present)
  • Often accompanied by headache
  • Common (about 16% have at least one migraine attack)

Very Different

  • Lasts 4 hours to 3 days
  • Symptoms may come on suddenly or gradually, and usually decrease gradually.
  • Aggravated by activity (patients prefer to lie down in a dark room)
  • More common in women, but men get it too
  • Attacks may or may not have a predictable pattern. (ie patients may get one attack in a lifetime, or attacks on a monthly cycle, etc)
  • Other typical symptoms: Auras (visual and otherwise), nausea, sensitive to light and/or sound


Similar

  • Usually one-sided pain
  • Congestion a common symptom

Different

  • Pain usually severe to very severe
  • Usually a sharp, burning pain
  • Almost always accompanied by headache
  • Rare (present in about 0.3%)

Very Different

  • Lasts 15 min to 3 hours
  • Headache usually comes suddenly – may reach peak intensity in 5-10 min, and decreases rapidly
  • Patients restless and agitated during and attack (prefer to pace or rock back and forth)
  • More common in men, but women get it too
  • Attacks come in a pattern or cycle: headache every other day up to 8 times a day (often the same time every day). Attacks occur in a series (cluster period) lasting for weeks or months, then a remission of months or years (some chronic sufferers have no remission periods)
  • Other typical symptoms: watery and/or red eyes, sweat, swollen or drooping eyelid, congestion, small pupil

You’ll see right away that I used terms like "usually" and "typically" a lot, and I probably could have used them more.  There is a lot of variation from person to person, so we’re just hitting on some of the more common, typical traits of each.  But just a reminder – either of these can include pain that’s not just on one side, sometimes there is no pain in migraine, sometimes it’s not throbbing pain, etc.

Key differences

You can see highlighted some of the key differences between migraine and cluster.  Cluster headaches come on faster and leave quicker than migraine attacks.  It’s unusual for a migraine attack to last less than 4 hours, and unusual for a cluster attack to last more than 3 hours.

Another key difference – migraine patients tend to avoid light and movement.  They’ll often go lie down in a dark room.

That’s the last thing a cluster patient wants to do – good luck getting them to lie down!  They become restless and may rock or pace.

But the last highlighted item is especially key.  Clusters get their name not from where the pain is or what it feels like, but from the cycles of pain.

You’re not going to get just one cluster headache.  You’ll get several in a series – maybe one a day, or several a day, regularly.  This can go on for weeks and even months, but then completely disappear for months or years.

Sad to say, there are also chronic cluster headache sufferers who have no periods of remission (as this recent news story on cluster headache illustrates).

Hopefully that clears up some misconceptions, especially regarding cluster.  Cluster is an incredibly painful condition.  There is treatment for cluster, but the treatment has had limited success in many people.  Much more research needs to be done to fight what has been rightly called the suicide headache.

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9 comments… add one
  • julie Jun 2, 2011

    Im pretty new to cluster but have had migraines all my life. They are definitely different. Most of the info that is available on cluster headaches is just confusing. It took a lot of digging for me to finally see that yes I do have both. My clusters go for months and usually involve stabbing pain in my right eye and blurred vision. Its very little like a migraine, however I have had both at the same time and that really sucks. Migraine and can’t stand light or noise but can’t sit still either.

  • giorgos Nov 3, 2013

    during my cycle(talking about the same cycle) sometimes I have an attack with the cluster characteristics and sometimes it’s with migrain characteristics. I mean dropping eye, nose runnig but the one nostril closed,watery eye..sometimes last 30 min. sometimes I have pain the whole day. sometimes I got nausea,sometimes I want to lie down and others I want to walk around. sometimes excersice fucks me up sometimes it makes me better..either I have a combination of both migrains and cluster or it’s the same thing and the symptoms depend from the person..

    • candace mann Sep 21, 2016

      I have had migrains since I can remember. I have had tests and neck surgery for ruptured discs and injections..etc…. the only relief I have ever gotten is from a prescription medication called Fiorinal. Not fioricett! (Which may help you though) I need Fiorinal. So, hope you can try this and it help you.

  • Cindy Nov 1, 2014

    I have spondylitis in my neck and a neck injury years ago. I wake up with a headache every day. They are on one temple and mostly are associated with nausea, light and noise and I have to lay down in a dark place. My head throbs and sometimes last several days with little relief. I don’t take my migraine medicine every day since I don’t want rebound headaches. I’ve tried Topamax which make my headaches worse. I’ve had epidural injections in my neck which haven’t worked and an ablation which only lasted 6 weeks. The headaches are debilitating and greatly disrupt my life. They totally suck. I’m ready for surgery which may or may not make it much better. I’m at the point now where I’m willing to take the chance cuz conservative methods ARE NOT working!

  • Jennifer May 18, 2015

    I have had cluster headache for three weeks straight on the left side of my head. I can’t stand noise or lights. I throw up. Motrin and Tylenol don’t help. I have to take tramadol everyday so all I do is sleep. But can’t take the pain. Makes me dizzy and headaches are marketing me feel confused an like my mind is in a fog. This sucks!

  • Diana May 27, 2015

    Sunday I suddenly had what I call an explosion in the middle of my brain that hit the top of my scull and melted down all over on the inside excruciating pain my vision got all messed up my son said that my eyes did weird things what happened next was after 20 or 30 minutes my body started twitching involuntarily all over I couldn’t remember people’s names people I’ve known almost all my life including my son I just got their names confused with other people’s names then I started seeing things what is this aneurysm stroke can anybody help me? pain in my head eventually stopped about by the next day it was gone but the twitching continued it’s gone now I don’t knowit’s very hard to walk around because I lose my breath quickly I get agitated very quickly

  • Melissa Mccandless Sep 5, 2016

    Hi. Just saw your post, have you been diagnosed with both migraine and cluster headaches? I’ve suffered migraines from a young age and feel symptoms similar to yours.. Can you get cluster and migraine symptoms together? Advice greatly appreciated from one another perspective.
    Hope your not suffering these anymore!

  • Jake Nov 4, 2016

    I don’t know much about cluster headaches, but if they’re really worse than the worst migraines I’ve ever had, then God be with yall that have them.
    I really think the pain threshold for migraines should be “moderate to very severe.” I’ve had them since I was in elementary school and I’m almost 30 now. They come in bouts of three to six back to back every month, lasting about a day each. Sometimes they’ll happen weekly. Rarely I’ll have one that’s not that bad, I’ll have the aura and then nothing happens (although I HATE the auras… they make me feel like my mind is literally splitting). But the majority of them are absolutely crushing. I’d be wrapped in a blanket on my bed with the lights off, cradling my head. They’re bad enough to make me whimper and moan in agony. And then there’s the vomiting that takes the pain to hellish depths. Imagine a pain that’s 15/10, and then multiply it several times because of all the sudden pressure in your head induced by vomiting. And then imagine that same otherworldly pain lasting for over 24 hours. No mercy.

    I’m feeling dizzy just thinking about this. I really hope this doesn’t trigger one for me… Oh god, why did I come to this page?

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