Knowing the Differences
Migraine disease and trigeminal autonomic cephalgia (TAC – which includes cluster headache) are two different primary headache disorders. While it is possible to have both, one does not morph into the other, the severity of migraine does not change the diagnosis, and there is no such thing as “cluster migraine”! Accurate diagnosis is crucial but can be tricky, so it’s important to work with a certified headache specialist who can help you navigate this process and figure out what treatments might have a higher success rate for you. Knowing some of these key differences between migraine and cluster will help with that process:
1. Speed of Onset
Migraine attacks: either come on quickly or build up slowly. There is a wide spectrum experienced with speed of onset, and they do not tend to end abruptly without treatment.
Cluster headache attacks: tend to come on fast and strong. It is common for a person experiencing a cluster attack to be pain free and then within a few minutes have a severe level of pain. The symptoms tend to end abruptly as well.
2. Location of Pain
Migraine attacks: generally begin unilaterally, but migraine is complex and the location can vary. Pain can start on one side of the head, face or behind one eye, but it can also move and spread throughout the head, switching sides, becoming bilateral, or even making the entire head feel like it’s going to explode.
Cluster headache attacks: remain strictly unilateral. The pain is always located in the orbital, suborbital and/or temporal region, and may also shoot pain through the other branches of the trigeminal nerve such as the sinus area or the teeth.
3. Length of Attack
Migraine attacks: last 4 -72 hours on average but some can last a week or even months. As with everything migraine, it is complex and on a spectrum. In addition, there are multiple phases: the “prodrome” begins up to two days prior to the actual pain, followed by aura (in some people), then the attack phase itself, and then postdrome..
Cluster headache attacks: last 15 minutes to 3 hours and can occur 1-8+ times per day. In between attacks a person is often pain free. The timing is very specific and abrupt. It often occurs at the same time every day for the length of the cycle. Remember this is without any medication; the attack will stop in this time frame without treatment.
4. Severity of Pain
Migraine attacks: range from mild to moderate to severe in terms of pain and other symptoms. During a migraine attack one person may be able to keep functioning partially, while another may end up in the emergency room or completely debilitated.
Cluster headache attacks: always considered severe. There is an element that can happen right before the cycle or in between attacks called shadows, which feel much like a cluster attack except dialed down to mild pain in comparison.
5. Other Symptoms
Migraine attacks: can include throbbing/stabbing pain; visual and/or speech changes; nausea and/or vomiting; light,sound, movement and/or odor hypersensitivity; autonomic symptoms (see the next paragraph for examples), and more. One telltale symptom is people generally need to lie down in a quiet, dark room and not move around at all.
Cluster headache attacks: generally include autonomic symptoms such as red and/or watery eyes, nasal congestion and/or runny nose, eyelid swelling, eye drooping, contracted pupil, forehead and/or facial sweating. One telltale symptom is the prevalence of restlessness rather than needing to lie still.
6. Pattern of Attacks
Migraine attacks: multiple different patterns depending on the person. They may occur during or before menstruation, as a result of triggers, during the night or early morning, midday, or even just over the weekends. The patterns can be as varied as the number of people with migraine, and can also change over time.
Cluster headache attacks: there is a very circadian pattern. Not all patients have the same pattern, but they may be able to discover their specific pattern. The most common date for a cluster cycle to start is with the spring equinox. The most common time of day is 2-4am. Many people can set their clocks to their attacks. Cycles typically last 2-14 weeks (but can last for months or years if it becomes chronic). During a cycle a person typically experiences 1-8+ attacks per day (at least one attack every other day). Because of the nature of cluster attacks, it’s common for those with episodic cluster attacks to be able to experience their triggers and not be affected, although when in-cycle there is a very low tolerance for triggers.
Even though migraine and cluster headaches are two different primary headache disorders, you can see quickly there is a lot of overlap between the two. There are key differences that can help a headache specialist figure out which one you are experiencing or even both. Having the correct diagnosis or diagnoses can help you get the right treatment options so that you can better manage life with migraine and/or cluster.
Let Us Know
Have you been diagnosed with migraine, cluster or both? Have you had trouble getting an accurate diagnosis? What has your diagnosis journey been like?