Is It a Migraine Attack or a Cluster Headache?

Migraine attacks and cluster headaches can both cause debilitating head pain. While pain from a migraine attack feels like pulsing or throbbing and is sometimes preceded by visual symptoms called aura, pain from a cluster headache is more severe and usually occurs suddenly.

Because these headache conditions have different treatments, learning to distinguish their symptoms, causes, and triggers is important.

Here’s what you need to know about these two types of headaches.

Signs and Symptoms of Migraine Attacks and Cluster Headaches

Migraine attacks and cluster headaches have some similarities, says Kiran Rajneesh, MD, a neurology and pain medicine specialist in Webster, Texas.

“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, says Merle L. Diamond, MD, a headache medicine specialist at Endeavor Health in Chicago.

Migraine Attacks

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, says Dr. Diamond.

• Mood changes, such as depressed mood
• Increased sensitivity to light, sound, or smells
• Fatigue or yawning
• Difficulty sleeping
• Nausea or vomiting
• Moderate or severe head pain

Cluster Headaches

“Cluster headaches feel like someone put a hot poker or sword through your eye,” Diamond says. "They are often confused with sinus headaches."

“Because the pain of a cluster headache is so severe, patients can become very agitated and restless,” says Rajneesh. Someone experiencing a cluster headache may pace around or sit and rock back and forth.

• Extreme sharp or stabbing pain on one side of the head, usually behind or around one eye
• Restlessness
• Tears in the affected eye
• Sweating on the forehead or face
• Swelling or redness on the affected eye
• Stuffy or runny nose

How Long Do Migraine Attacks and Cluster Headaches Last?

During a cluster period, headaches usually come every day, often several times per day. Cluster headaches are more likely to occur at night.

Migraine and Cluster Headaches Can Get Better With Age

Causes and Triggers of Migraine Attacks and Cluster Headaches

• Alcohol
• Smoking or secondhand smoke
• Weather changes
• Bright light
• Physical exertion
• Certain medicines, oral contraceptives, and vasodilators (medicines that treat high blood pressure and heart failure)
• Foods containing nitrates, such as processed meat

Other factors that can trigger migraine attacks include the following:

• Hormonal changes, such as during menstrual periods, pregnancy, and menopause
• Too much or not enough sleep
• Flashing lights, loud sounds, and strong smells
• Stress
• Caffeine

Treatment Options for Migraine Attacks and Cluster Headaches

Treatment for both migraine attacks and cluster headaches involves acute medications at the onset of symptoms and preventive therapies to keep them from recurring, says Richard Lipton, MD, a professor and the vice chair of the department of neurology at the Albert Einstein College of Medicine and the director of the Montefiore Headache Center in New York City.

Acute Treatments for Quick Relief

• Triptans work by increasing levels of serotonin in the brain. They are the standard treatment for migraine. Common triptans include sumatriptan (Imitrex, Onzetra, Tosymra), naratriptan (Amerge), zolmitriptan (Zomig), rizatriptan (Maxalt), almotriptan, frovatriptan (Frova), and eletriptan (Relpax).

  [10]

• Over-the-counter pain relievers help relieve the pain of less-severe migraine attacks. They include ibuprofen (Advil, Motrin IB), aspirin, and acetaminophen.

  [1]

• Ergots bind to serotonin receptors and reduce the transmission of pain signals. They include ergotamine (Cafergot, Ergomar, Migergot) and dihydroergotamine (Brekiya, Migranal, Trudhesa).

  [11]

  [12]

• Calcitonin gene-related peptide (CGRP) antibodies, also called gepants, prevent the activation of specific nerves in the brain related to pain. They include ubrogepant (Ubrelvy), rimegepant (Nurtec ODT), and zavegepant (Zavzpret).

  [13]

• Nausea-relief drugs ease nausea symptoms of migraine headaches. They include chlorpromazine (Thorazine) and metoclopramide (Reglan, Gimoti).

  [14]

• Oxygen therapy involves breathing in pure oxygen through a mask. It can relieve symptoms of a cluster headache within 15 minutes.
• Lidocaine is a local anesthetic. It has a numbing effect, which may help reduce cluster headache pain when taken as a nasal spray.
• Octreotide (Sandostatin) is a brain hormone given as an injection. It may be an option for people who don't respond well to triptans.

Fast treatment is advisable for cluster headaches, Diamond says, because the pain is so severe. “Injectables and 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.

Preventive Treatments

• Antiseizure medications may help calm the activity of nerve cells in the brain. Common antiseizure medications for migraine include topiramate (Topamax) and divalproex sodium (Depakote).
• Antidepressants help balance neurotransmitter levels in the brain that fluctuate during a migraine attack. Common antidepressants for preventing migraine include tricyclic antidepressants such as amitriptyline and nortriptyline (Pamelor, Aventyl), as well as serotonin norepinephrine reuptake inhibitors such as venlafaxine (Effexor).

  [16]

• Beta-blockers treat high blood pressure and can also help prevent migraine attacks. Common beta-blockers for migraine include propranolol and timolol.

  [17]

• Verapamil (Calan SR, Verelan) is a type of calcium channel blocker. It prevents blood vessels from narrowing or widening, which can trigger migraine symptoms.
• Monoclonal antibodies are a type of CGRP inhibitor. They help prevent migraine attacks by blocking nerve signals that cause headache pain. Common monoclonal antibodies for preventing migraine include erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality), and eptinezumab (Vyepti).

  [18]

• Corticosteroids, such as prednisone (Prednisone Intensol, Rayos), provide short-term relief for cluster headaches but can cause serious side effects with long-term use, including diabetes, high blood pressure, and osteoporosis. They're often used together with verapamil.
• Galcanezumab (Emgality) is a type of monoclonal antibody. It is taken as a monthly shot to prevent episodic cluster headaches until a cluster period ends.

  [19]

• Lithium (Lithobid) is commonly used to treat bipolar disorder and may also help prevent chronic cluster headaches if other medications aren't effective. However, it can cause side effects, such as tremor, increased thirst, and kidney problems.
• Noninvasive vagus nerve stimulation involves using a handheld controller to send electrical stimulation to your vagus nerve through the skin. The vagus nerve connects your brain to the rest of your nervous system and plays a role in regulating pain.

  [20]

• Nerve blocking involves injecting a pain-relieving medication into the back of your head, which acts on your occipital nerve. It is often combined with verapamil for short-term relief.

Whether you have migraine or cluster headaches, it’s important to see a healthcare professional for treatment, Rajneesh urges. “Managing cluster headaches and migraine not only relieves pain, it can also restore a sense of normalcy,” he says.

Additional reporting by Becky Upham.