Is It a Migraine Attack or a Cluster Headache?

Whether you’re having a migraine attack or a cluster headache, the pain it causes can be debilitating.

But because the treatments for the two diseases are very different, it’s crucial to figure out which you have — or whether you have something else entirely — to have the best chance of easing your pain.

Without the correct diagnosis, it’s difficult to find relief for your headache, says Merle L. Diamond, MD, the president and medical director of the Diamond Headache Clinic in Chicago.

Here’s what you need to know about the symptoms, causes, and treatment options for these two types of headaches.

Migraine attacks and cluster headaches have some similarities, says Kiran Rajneesh, MD, who specializes in neurology and pain medicine at the Ohio State University Wexner Medical Center in Columbus.

“They are both headaches, they both can be unilateral (one-sided), and both can involve the forehead,” Dr. Rajneesh says.

Despite those similarities, there are many ways to distinguish between the two. Migraine attacks and cluster headaches feel and act differently, according to Dr. Diamond.

People with a migraine attack may experience nausea, vomiting, and sensitivity to light, while those with a cluster headache experience watery eyes and a runny nose, she says.

Some people who experience migraine attacks can predict the onset because it's preceded by an aura, usually in the form of visual disturbances — such as flashing lights, zigzag lines, or a temporary loss of vision.

By contrast, cluster headaches occur suddenly, almost always cause symptoms on one side of the head, 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.

Whereas a cluster headache is associated with a piercing and very intense pain, the pain of a migraine attack is usually described as a pulsing sensation or throbbing pain. It’s usually moderate in intensity and rarely severe, says Rajneesh.

People also tend to respond to migraine attacks and cluster headaches differently. To ease migraine pain and other symptoms, people often find relief by resting in a quiet, dark room.

In contrast, most people with cluster headaches pace around and can sometimes exhibit aggressive behavior, says Rajneesh. “Because the pain of a cluster headache is so severe, patients can become very agitated and restless,” he notes.

A migraine attack typically lasts between 4 and 72 hours, says Rajneesh. That’s longer than a cluster headache tends to last, which is between 15 minutes and three hours.

Most people with migraine have one or two migraine attacks per month, but some people have them much more frequently. About 1 percent of the population has chronic migraine, which is defined as at least 15 headache days per month, with migraine features on at least 8 of those days, for three months.

Cluster headaches usually come in bouts, or “cluster periods.” These periods can last for weeks or months, and are separated by remission periods lasting months or years.

During a cluster period, the frequency of headaches can range from once every other day to as many as eight times per day.

Migraine often begins in adolescence and tends to peak in a person’s thirties, with attacks often becoming less frequent and severe over the following decades, according to the Mayo Clinic.

Many women experience worsening migraine symptoms in the months or years before they go through menopause (a period known as perimenopause), according to the American Migraine Foundation. But when menopause occurs, migraine attacks tend to become less frequent and may even stop completely.

The typical age of onset for cluster headaches is between 20 and 40, according to the American Migraine Foundation. People may not “age out” of cluster headaches entirely, but the amount of time between bouts of cluster headaches usually increases with age, leading to fewer headaches, per the Migraine Trust.

Genetics play a significant role in migraine. If one or both of a person’s parents have migraine, there’s a 50 to 75 percent chance that they will, too, according to the American Migraine Foundation.

Genetics are believed to less strongly influence the occurrence of cluster headaches. If you have a family history of cluster headaches, research shows your likelihood of having this condition is about 6 percent.

The underlying cause of cluster headaches is not known. Experts believe they’re caused by the interaction of abnormalities in blood vessels, nerves, and chemicals that your body produces, per Mount Sinai.

Alcohol may trigger both types of headaches, but migraine attacks may also be triggered by hormonal fluctuation (like what occurs with menstruation) and relaxation after stress, says Richard Lipton, MD, a professor and vice chair of the department of neurology at the Albert Einstein College of Medicine and director of the Montefiore Headache Center, both in New York City.

Both cluster headaches and migraine attacks are treated using what are known as acute medications, usually taken at the onset of symptoms, as well as preventive therapies, which aim to keep the headaches or attacks at bay, Dr. Lipton says.

Acute Treatments for Quick Relief

Acute medications for migraine that have been used for years include a class of drugs called triptans, as well as nonsteroidal anti-inflammatory drugs (NSAIDs).

Two newer classes of medications approved to treat acute migraine are gepants and ditans. Gepants are unique in that they are not associated with medication-overuse headache, a kind of headache that can occur when people overuse acute migraine medications, according to the American Migraine Foundation.

For cluster headaches, standard treatments include injectable triptans and high-flow oxygen, says Lipton.

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.

A nerve block can also be used to treat cluster headaches, says Rajneesh. This in-office procedure — in which a numbing agent, or anesthetic, is injected into the scalp near particular nerves — can improve cluster headache symptoms for a few weeks to a few months, he notes.

RELATED: How to Get Rid of a Headache or Migraine Attack Fast

Preventive Treatments

According to both Lipton and Diamond, if migraine attacks occur regularly, preventive medications should be taken daily to help prevent them. These drugs include beta-blockers (propranolol or timolol), anti-seizure drugs such as topiramate (Topamax), and some types of antidepressants.

Some types of birth control pills can improve migraine symptoms in women, though for some women these medications can increase the risk of stroke or heart disease, according to the American Migraine Foundation.

Cluster headache prevention may include daily doses of verapamil (a calcium channel blocker), with or without a short course of steroids.

Whether you have migraine or cluster headaches, it’s important to see a healthcare professional for treatment, Rajneesh urges. “Managing pain in cluster or migraine not only gives the person pain relief, but it can also restore a sense of normalcy from these severe headaches so that a person can enjoy their family, jobs, and hobbies more fully,” he says.

Additional reporting by Becky Upham.