From the Guidelines
Cluster headaches and migraines are two distinct primary headache disorders with different clinical characteristics.
Key Differences
- Cluster headaches are typically marked by severe, unilateral orbital or periorbital pain lasting 15-180 minutes, often accompanied by ipsilateral cranial autonomic symptoms, such as conjunctival injection, lacrimation, and nasal congestion 1.
- In contrast, migraines are characterized by moderate to severe, often unilateral, throbbing headaches lasting 4-72 hours 1.
Clinical Features
- Cluster headaches affect ~0.1% of the general population and are highly characteristic, with frequently recurrent but short-lasting attacks 1.
- Migraines, on the other hand, are more prevalent and can be accompanied by symptoms such as aura, photophobia, and phonophobia, which are not typically seen in cluster headaches.
Diagnosis and Management
- A differential diagnosis is crucial to distinguish between cluster headaches, migraines, and other primary and secondary headache disorders, such as tension-type headache and medication-overuse headache 1.
- Accurate diagnosis is essential for effective management, as treatment options vary significantly between these conditions, with cluster headaches often requiring high-flow oxygen or triptans, and migraines frequently managed with triptans, ergotamines, and preventative medications.
From the Research
Differences between Cluster Headache (CH) and Migraine
- Cluster headache and migraine are regarded as distinct primary headaches, differing in multiple aspects such as gender-related and headache specific features (e.g., attack duration and frequency) 2
- Cluster headache is characterized by severe unilateral orbital, supraorbital, and/or temporal pain, lasting from 15 to 180 minutes if untreated, associated with at least one of various autonomic symptoms during the headache 3
- Migraine, on the other hand, is often characterized by nausea, vomiting, photophobia, and phonophobia, although some cluster headache patients may also experience these symptoms 4
Similarities between Cluster Headache (CH) and Migraine
- Both cluster headache and migraine show clinical similarities in trigger factors (e.g., alcohol) and treatment response (e.g., triptans) 2
- Some patients with cluster headache may experience migrainous aura preceding the attacks, and a large number of cluster headache patients do not receive adequate treatments 4
Treatment of Cluster Headache (CH)
- Triptans, such as sumatriptan by injection, high flow 100 % oxygen by face mask, or non-invasive vagus nerve stimulation, are mainstay acute treatments of attacks of cluster headache 5
- Interim preventive treatments to reduce attack frequency include a short course of high dose oral corticosteroids, local anesthetic/corticosteroid injection around the homolateral greater occipital nerve or the CGRP monoclonal antibody galcanezumab 5
- Verapamil is considered the mainstay medium to long-term preventive with additional options being lithium, melatonin, topiramate, or non-invasive and invasive neuromodulation 5
Recent Advances in Cluster Headache (CH)
- Recent advances have introduced effective treatments and broadened understanding of the clinical features of cluster headache, including the introduction of galcanezumab, a monoclonal antibody targeting CGRP, as the first specific preventive treatment for episodic cluster headache 6
- International collaborations have led to identification of eight genetic loci associated with cluster headache, and targeting the trigeminal autonomic reflex by neurostimulation, or targeting the neuropeptide calcitonin gene-related peptide (CGRP), might lessen the attack burden 6