Almost everyone has suffered severe pain sometime in their life, whether it was pain from a broken bone, child birth or a painful, throbbing headache. You understand when someone says their pain was excruciating. Unfortunately, there are currently over 30 million people suffering from excruciatingly painful headaches, that occur over and over, due to migraine and cluster headaches. Both types of headaches incur debilitating pain, both are considered vascular headaches (pain due to blood vessel dilation), and both tend to run in families. If you have a first degree relative with either type of headache you are much more likely to be diagnosed with that type of headache yourself. Cluster headaches often go undiagnosed for years as they are confused with migraine. So how do you know if you are suffering from frequent migraines or if you have cluster headaches?
There are differences between the two. Migraine is fairly common and sufferers are most often female (1 in 5 women and 1 in 15 men are diagnosed with migraine) whereas cluster headache sufferers are rare (0.5% of the population) and predominantly male. Migraine headaches are most common in people between the ages of 25 to 55 although children and teens also are diagnosed with it. The migraines often start in childhood, adolescence or young adulthood. The onset of cluster headaches typically begins in the late 20’s although there are exceptions. There are many similarities as well as differences, so let’s look at a quick review of both types of severe headache and then compare the two.
What is Migraine?
Migraine is generally considered a disorder that is characterized by recurring attacks of severe headache, although there are exceptions (see below under “Types”). A typical migraine headache is described as throbbing, pulsating pain that tends to be on one side of the head. They are often accompanied by nausea, vomiting, or sensitivity to light or sound. They can last from 2 to 4 hours or as long as 3 days. Although migraine headaches are sometimes initially misdiagnosed as sinus or tension headaches, the key is the severity of the pain which causes interference with a person’s sleep, work, or other everyday activities. They have been reported as frequently as several times a week or as seldom as once or twice a year. The pain is so severe it causes the person to want to seek a dark place and just lie down.
The cause of migraines is still unknown; it appears to be a mix of both genetic and environmental factors. Approximately 2/3 of the cases run in families. Fluctuating hormone levels are also suggested as a cause; prior to puberty migraine affects males and females equally yet after puberty it affects 2 to 3 times as many females as males. There are many biological and environmental factors that are associated with it (see “Triggers” below).
Common migraine: This is the most prevalent type of migraine and accounts for about 80% of cases. It is also called a ‘migraine without aura’.
Classic Migraine: The classic migraine occurs only in about 20% of the migraine cases. It is also called ’migraine with aura’ as visual or other sensory symptoms (called auras) most often occur just before a migraine headache begins. There are several subtypes of classic migraine including:
- Menstrual migraine
- Abdominal migraine
- Retinal migraine
- Familial hemiplegic migraine
- Basilar artery migraine
- Ophthalmoplegic migraine
Chronic Migraine: This is where migraines become so prevalent that they become almost a chronic daily headache; it becomes a continuous background headache with occasional bouts of severe migraine symptoms. The diagnosis is given if migraines are present 15 or more days per month for at least 3 months.
Migraines can progress through 4 stages although not everyone experiences all 4, and even those that do may not every time. The stages in order are: Prodrome (occurs hours or days before the headache), Aura (occurs immediately before the headache), Pain or Attack (the actual headache phase), and Postdrome (occurs after the headache has passed). The symptoms vary according to the stage.
- Food cravings
- Neck stiffness
- Visual phenomena
- Vision loss
- Pins and needles sensations in an arm or leg
- Speech or language problem
Attack or Pain:
- Moderate to severe pain on one side of the head (bilateral pain is common, especially in Migraine Without an Aura)
- Pain that is throbbing or pulsating
- Sensitivity to light, sounds or smells
- Nausea and vomiting
- Blurred vision
- Lightheadedness sometimes followed by fainting
- May feel drained or washed out (though some report feeling refreshed or euphoric)
- Sore feeling where the migraine was
- Hormonal changes in women
- Foods (common ones include beer, red wine, aged cheeses, chocolate, aspartame)
- Fasting or skipping meals
- Sensory stimuli (bright lights, sun glare, loud sounds, second hand smoke, etc)
- Changes in wake-sleep pattern (jet lag, too much/too little sleep)
- Intense physical exertion (including sexual activity)
- Changes in environment (weather change, barometric pressure change)
What are Cluster Headaches?
Cluster headaches occur in cycles-or clusters- which gives the headache its name. They are characterized by an excruciating one-sided pain centered by the eye or temple. It is one of the most painful headaches a person can experience. Some doctors have reported that the pain is worse than that of burns, broken bones or childbirth. The pain is described as feeling like a red hot poker being inserted into the eye or having a leg amputated without anesthesia. A cluster headache strikes quickly and usually without warning. The pain lasts 15 minutes up to 3 hours and can recur several times in a day. Cluster headaches tend to occur with clocklike precision, commonly awakening the person several hours after they have fallen asleep. The bouts of frequent attacks, called cluster periods, often follow the seasons of the year occurring just after daylight savings time changes and around the spring and autumn equinox. The cluster periods may last from weeks to months and are usually followed by remission periods when the cluster headaches completely disappear. Cluster headache sufferers appear restless-pacing the room or rocking back and forth to try to soothe the pain.
The exact cause of cluster headaches is unknown although abnormalities in the hypothalamus are suspected. Biochemical, hormonal and vascular changes all can induce cluster headaches but the cause for the changes is still unclear.
- Excruciating pain, located in or around the eye (may radiate to face, head, neck, shoulders)
- Almost always one-sided
- Excessive tearing
- Redness in the eye of the affected side
- Stuffy or runny nasal passage in the nostril of affected side
- Sweaty, pale skin on the face
- Swelling around the eye on the affected side
- Reduced pupil size
- Drooping eyelid
- Change in length of day
- Decreased blood oxygen levels (happens during the night when sleeping)
Comparison= Cluster vs. Migraine
Characteristics of pain
more common in males
more common in females
Sensitivity to light/sound
Runny nose and red, watery eye
Location of pain
deep stabbing pain around eye/temple
near the eye on affected side
Severity of pain
Moderate to Quite Severe
Time of Onset
Short; headaches peak within 45 minutes
long; gradually peaks 4-24 hrs
nitroglycerin, petroleum solvents, perfume, alcohol, napping etc
bright lights, loud noise, changes in, sleep patterns, smoke, fasting, etc
Nausea or Vomiting
Preferred Position during Headache
pacing, rocking back and forth
lying down in dark room