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Is It a Migraine Attack or a Cluster Headache?

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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.

Some people with migraine can predict attacks because they are preceded by an aura. An aura usually causes visual disturbances, such as flashing lights, seeing shapes, or a temporary loss of vision.

Migraine attacks cause a pulsing, throbbing pain. People experiencing migraine pain often seek relief by resting in a quiet, dark room.

Common symptoms of migraine include the following:

  • 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

A cluster headache usually occurs suddenly and causes a piercing, intense pain on one side of the head. It is often accompanied by tears and a stuffy or runny nose on the same side of the head that hurts.

“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.

Common symptoms of a cluster headache include the following:

  • 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?

A migraine attack typically lasts between 4 and 72 hours, says Rajneesh. Most people with migraine have two to four migraine attacks per month, but some people have them much more frequently. They are more common in the morning.

About 3 to 5 percent of people in the United States have chronic migraine. Chronic migraine is defined as at least 15 headache days per month for more than three months, with migraine symptoms on at least eight of those days.

Cluster headaches tend to last between 15 minutes and three hours, and they usually come in bouts, called cluster periods. These periods can last for weeks or months, and are separated by remission periods lasting months or years. Cluster periods may start around the same time each year and last for the same amount of time.

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

Migraine often begins in adolescence and tends to peak in a person’s thirties, with attacks gradually becoming less frequent.

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

Cluster headaches typically start when people are in their thirties or forties. The amount of time between cluster periods usually increases with age, leading to less frequent headaches.

Causes and Triggers of Migraine Attacks and Cluster Headaches

Genetics play a significant role in migraine. If you have a family history of migraine, you are more likely to have the disorder.

Experts aren't yet sure what causes cluster headaches, but they may be related to a sudden release of histamine (a chemical released during an allergic response) or serotonin in an area of the face called the trigeminal nerve. The hypothalamus, a part of the brain that produces hormones, may also be involved.

A number of common factors can trigger both migraine attacks and cluster headaches, and they can be different for each person:

  • 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

Short-term treatment for a migraine attack may include the following medications:

  • 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).

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

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

  • 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).

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

Triptan and ergot medications can also treat cluster headaches. Other short-term treatments for cluster headaches may include the following:

  • 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

According to both Dr. Lipton and Diamond, if migraine attacks occur regularly, the following daily treatments may help prevent them:

  • 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).

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

  • 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).

Verapamil is often a first-line treatment for preventing cluster headaches. Other treatments to prevent cluster headaches may include the following:

  • 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.

  • 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.

  • 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.

The Takeaway

  • Migraine pain is typically pulsing or throbbing, and it can be preceded by visual disturbances called aura. Other migraine symptoms include sensitivity to light and sound, nausea, and vomiting. Cluster headaches cause a sudden and severe pain on one side of the head, usually around an eye. Other cluster headache symptoms include tears in the affected eye and a stuffy or runny nose.
  • Migraine attacks last between 4 and 72 hours, with most people experiencing two to four attacks per month. Cluster headaches are shorter, lasting 15 minutes to three hours. They typically occur in cluster periods spanning weeks or months.
  • Both migraine and cluster headaches are managed with acute treatments and preventive therapies. Triptan medications and over-the-counter pain relievers are commonly combined to treat acute migraine attacks. Oxygen therapy is the fastest treatment for acute cluster headaches.

Additional reporting by Becky Upham.

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