Key Features of Cluster Headache vs. Migraine Symptoms
Medically reviewed by Brigid Dwyer, MD
Cluster headaches and migraines are complex headache disorders associated with significant and sometimes alarming symptoms, although they are not dangerous.
While these two headache types share some features like trigger factors (e.g., alcohol), they are quite different in other elements, namely headache quality (what it feels like), duration, pattern of attacks, and genetic basis.
This article will review the essential differences between cluster headaches and migraines. It will also provide insight into seeking care for a severe headache.
Cluster Headache vs. Migraine: How to Tell the Difference
Features like headache quality, associated symptoms, frequency, and duration are valuable clues when distinguishing a cluster headache from a migraine.
Photo composite by Amelia Manley for Verywell Health; Getty Images
Quality and Symptoms
Cluster headaches always occur on one side of the head, causing unbearable pain in the trigeminal nerve distribution (in or around the eye, eyebrow, or temple).
The quality of pain is piercing, stabbing, or burning and is reported as comparable to or more severe than passing a kidney stone, breaking a bone, or having a hot poker penetrate the eye. Restlessness and agitation typically accompany cluster headaches.
Also, at least one of the following cranial autonomic symptoms is present (on the same side as the headache):
Red or teary eye
Runny or congested nose
Swollen eyelid
Sweaty forehead and face
Related: The Symptoms of a Cluster Headache
A migraine headache is often unilateral (located on one side of the head) but, unlike cluster headaches, can be bilateral (on both sides). The pain is throbbing or pounding, typically worsened by regular physical activity.
One or both of the following symptoms accompany a migraine headache:
Light sensitivity (photophobia) and sound sensitivity (phonophobia)
Moreover, in approximately one-third of people with migraine, an aura precedes the headache.
What Is an Aura?
A migraine aura lasts up to an hour and consists of neurological symptoms, like seeing flashing lights, or smelling or hearing things that aren't there (hallucinations).
Some people with migraines also experience prodrome and postdrome phases, which are:
The prodrome phase begins up to three days before the headache and includes various symptoms, such as excessive yawning, food cravings, mood changes, and insomnia.
The postdrome phase occurs after the headache, lasts up to two days, and consists of symptoms like mood changes, trouble concentrating, fatigue, and neck stiffness.
Related: The Symptoms and Stages of a Migraine Attack
Frequency
Cluster headaches occur between once every other day and up to eight times daily. They tend to follow a circadian pattern (24-hour biological clock), manifesting at the same time each day, often in the middle of the night.
They also occur in cycles. Many people experience multiple cluster headaches for six to 12 weeks, followed by remission (period of no attacks), lasting months to years. An exception is people with chronic cluster headaches whose remission lasts less than one month.
In addition to a circadian pattern, cluster headache cycles usually coincide with changes in the seasons, with episodes peaking in spring and autumn.
Unlike cluster headaches, migraine is not generally a cyclical disorder. One classic exception is menstrual migraine, which develops around the time of a person's menstrual period. It stems from the sudden drop in estrogen levels just before menstrual flow.
People with chronic migraines have at least 15 migraine attacks per month.
Duration
Cluster headaches are short and intense. They last from 15 minutes to three hours, averaging 45 to 90 minutes.
Migraine headaches last four to 72 hours, although entire attacks—including all four phases (prodrome, aura, headache, and postdrome)—typically last one to two days.
Effect on Quality of Life
Cluster headaches are excruciating and associated with a decreased quality of life. People with cluster headaches commonly report depressive symptoms and, compared to the general population, are more likely to report suicidal ideation (thoughts or ideas of suicide).
Get Help Right Away
If you have thoughts of suicide, dial 988 to contact the 988 Suicide & Crisis Lifeline and speak with a trained counselor. If you or a loved one are in immediate danger, call 911.
Like cluster headaches, migraines negatively impact the quality of life, including family, work, and social relationships.
They are also associated with various mental health conditions, namely depression, anxiety, and post-traumatic stress disorder (PTSD).
Overlapping but Different Causes
Experts aren't sure of the exact cause of cluster headaches. However, the hypothalamus (a gland at the base of the brain) and the trigeminal nerve pathway are believed to play a substantial role. In addition, various triggers, namely alcohol and strong odors, can trigger cluster headache attacks.
Similarly, the trigeminal nerve is also involved in migraine attacks. Likewise, alcohol and strong odors are among the triggers that can precipitate a migraine attack. Unlike cluster headaches, which do not tend to run in families, genetics significantly contributes to migraine development.
Related: Researchers Identify New Genetic Risk Factors for Migraines
Who Gets Cluster Headaches vs. Migraines?
Cluster headaches affect up to 0.1% of the population and are between 2 and 3 times more common in males than females. (Note that the terms for sex or gender in this article are taken from the sources cited.)
They can occur at any age but rarely develop in children. Interestingly, people who smoke are at a higher risk for developing cluster headache disorder.
Related: Relationship Between Smoking and Headaches
Migraines are much more common, affecting around 12% of the population, equivalent to 39 million individuals in the United States.
Unlike cluster headaches, migraines are more common—twofold to threefold—in females vs. males. They also occur in 3% to 10% of children and adolescents.
Related: An Overview of Pediatric Migraines, Symptoms, and Treatment Methods
How to Relieve Cluster Headache and Migraine Pain at Home
There is no cluster or migraine headache cure. However, combined with medication, various home remedies can help soothe such headaches.
Cluster
Since cluster headaches come on exceptionally quickly and severely, carry your medicine (or portable oxygen) with you at all times to immediately manage pain at symptom onset.
Also, because some people find that applying cold water or cooling pads to the painful area is helpful, it's reasonable to consider carrying a water bottle or instant cold pack in your purse, briefcase, or backpack.
Lastly, avoid cluster headache triggers like alcohol and strong odors (e.g., petrol, paint fumes, perfume, or bleach) during a cycle of attacks.
Migraine
A crucial difference between migraine and cluster headaches is that sleep can help soothe a migraine headache, whereas, with a cluster headache, a person is agitated, often pacing around a room or rocking back and forth.
Besides sleeping in a dark, quiet room, other migraine home remedies include:
Placing a cold compress or ice pack (over a towel) on your neck
Performing gentle neck stretching exercises
Drinking water, especially if vomiting is occurring
Avoiding triggering or aggravating factors like exercise or alcohol
Related: What to Know About Migraine Triggers
Medications for Each Type of Headache
Medication is often required to abort a cluster or migraine headache.
Cluster
The primary abortive therapies for cluster headaches are home oxygen therapy and a medication class called triptans.
Oxygen is safe, well-tolerated, and very effective in aborting cluster headaches. Research has found that nearly 80% of people experiencing a cluster headache are pain-free 15 minutes after receiving high-flow oxygen therapy delivered via a face mask.
Triptans are prescription drugs that attach to serotonin (chemical messenger) receptors, altering blood flow and pain signaling within the brain.
The triptans used for cluster headaches are:
Imitrex (sumatriptan) is available as a subcutaneous shot (into the fatty tissue, below the skin) or a nasal spray/powder.
Zomig (zolmitriptan) is available as a nasal spray.
Oral preparations of these drugs are not preferred for aborting cluster headaches.
Drawback of Triptans
Because they constrict blood vessels, triptans cannot be used in people with certain underlying health conditions, namely heart disease, stroke, peripheral artery disease, or significant high blood pressure.
Other less commonly used abortive therapies for cluster headaches include:
Lidocaine (a numbing agent) is given through the nose (on the same side as the headache).
Ergomar (ergotamine) is a sublingual tablet (applied underneath the tongue).
Preventive Cluster Headache Medications
Preventive cluster headache medications are intended to reduce the number of attacks and the duration and severity of the cluster cycle.
Examples include:
A heart medicine called Calan (verapamil)
A calcitonin gene-related peptide (CGRP) antibody called Emgality (galcanezumab)
Migraine
Migraine headaches that are mild to moderately severe may be alleviated with one of the two over-the-counter (OTC) painkillers:
Tylenol (acetaminophen)
A nonsteroidal anti-inflammatory drug (NSAID) like Advil, Motrin (ibuprofen), or Aleve (naproxen sodium).
Learn More: Tylenol or Advil for Headache
Moderate to severe migraine headaches are usually treated with a triptan, of which seven are Food and Drug Administration (FDA)–approved in the United States.
Which triptan is prescribed for your migraine care depends on factors like associated symptoms, migraine type, and age (some are approved to treat children).
For example, if vomiting accompanies your migraine headaches, a healthcare provider will likely recommend a triptan given through the nose or as a shot.
Other medications that can stop a migraine include:
Excedrin Migraine is a combination of acetaminophen, aspirin, and caffeine.
Treximet (sumatriptan/naproxen) is a combination NSAID and triptan.
Reyvow (lasmiditan) is a drug that targets serotonin but is safe in people with or at risk for heart disease (unlike triptans).
Nurtec ODT (rimegepant), Ubrelvy (ubrogepant), or Zavzpret (zavegepant) are drugs that block the effect of CGRP.
Reglan (metoclopramide) is an antinausea medication.
Migranal (dihydroergotamine mesylate) is an ergotamine nasal spray.
Learn More: Medications for Treating Migraine Headaches
Preventive Migraine Medications
You may be a candidate for preventive migraine therapies if you have frequent or prolonged migraine headaches.
Examples include:
An anti-seizure drug called Topamax (topiramate)
A high blood pressure drug called Inderal (propranolol)
A calcitonin gene-related peptide (CGRP) inhibitor such as Aimovig (erenumab), Vyepti (eptinezumab), or Emgality (galcanezumab-gnlm)
Seeing a Neurologist for Severe Headache Pain
While the symptoms of cluster headaches and migraines are often alarming, they are not dangerous conditions.
That said, seeing a neurologist (a medical doctor specializing in nervous system conditions) or headache specialist is important if you think you may be experiencing one of these disorders.
Diagnostic Evaluation
A migraine diagnosis usually requires a thorough medical history and neurological exam, whereas a cluster headache diagnosis requires additional imaging or other tests to rule out mimicking conditions.
Also, see a healthcare provider if you have a new headache and any of the following pertain to you:
You are older than 50.
You are pregnant.
You are postpartum.
You are immunocompromised.
Likewise, if you have been diagnosed with cluster headaches or migraines, see a healthcare provider if your headaches occur more frequently or become more severe.
Go to your emergency room or call 911 right away if:
Your headache begins abruptly and becomes severe within a few seconds or minutes.
Your headache is accompanied by a fever, stiff neck, seizure, passing out, confusion, or stroke symptoms (e.g., word slurring or one-sided numbness).
Your headache developed after a head or neck injury.
Related: When Should You Worry About a Headache?
Summary
Cluster and migraine headaches are debilitating, although they differ significantly in pain quality and location, duration, and pattern.
Cluster headaches are short-lived, stabbing, excruciating, and strictly one-sided. They are accompanied by intense restlessness and occur in cycles up to eight times daily for weeks, followed by periods with no headache.
Migraine headaches are throbbing, located on one or both sides of the head, and are associated with nausea, vomiting, and light and sound sensitivity. A typical migraine attack may last days and involves four phases—prodrome, aura, headache, and postdrome.
Other differences are that migraine headaches are more common in females, whereas cluster headaches are more common in males. Moreover, while genetics plays a significant role in migraine development, cluster headaches do not usually run in families.
While some drugs treat cluster and migraine headaches, namely triptans, oxygen therapy is the hallmark treatment for cluster headaches.
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