Migraine vs. Cluster Headache

Medically Reviewed by Melinda Ratini, MS, DO on May 09, 2024
5 min read

Your eyes water. Your nose runs. One side of your head really hurts. You may wonder: Is it a cluster headache or migraine attack?

These two neurological conditions have some things in common. They each cause disabling headaches that might make you feel a little sick. And they share triggers such as stress, lack of sleep, and weather changes. But there are some key differences.

It’s possible to have both migraine and cluster headaches, but your treatment depends on which one is causing your pain. Your doctor can help you figure out what’s going on. Here are some questions they may ask.

The length of time is a big clue.

A cluster headache is brief, but it comes on fast and strong. It’s sometimes described as “explosive.” The pain may peak within 10 to 15 minutes and vanish within 15 minutes to 2 hours. It may last longer, but that’s uncommon.

Migraines tend to build up slowly and last a long time. If left untreated, it can stick around for up to 72 hours. Symptoms can impact daily life, but migraines are considered less intense than a cluster headache.

Cluster headaches tend to happen around the same time every day for weeks or months, usually in spring or fall. During a cluster, you could have a headache every other day or up to eight in 1 day. Some may wake you up at night. But then you can have pain-free periods for weeks or years.

Migraine pain may go up and down throughout the day. But it’s rare to have more than one headache a day. And unlike cluster headaches, migraines are more likely to happen during the day and don’t seem to follow a seasonal pattern.

A cluster headache is unilateral. That means it only affects one side of your head. You may feel like it’s right behind your eye or on the side of your forehead. The pain may switch sides in another attack, but it won’t cross over during an episode.

One-sided head pain is also common with migraines. But you can have a headache that’s behind your eye, by your temple, on both sides, or in the front or back of your head.

Cluster headache and migraine have some of the same symptoms. That’s one reason they’re easy to mix up. But there are some factors that set them apart.

Cluster headaches often give you a sense of restlessness. You may feel better if you walk around. Your face or forehead may also start to sweat.

A cluster headache also causes continuous pain. And you’ll usually have some symptoms on the same side as your headache. That may include:

  • Watery or red eye
  • Nasal congestion
  • Runny nostril
  • Puffy eyelid
  • Droopy eye

Migraine headaches usually give you the urge to lie down and rest. In fact, your pain may get worse when you’re active.

A migraine may cause some constant pain, but it usually throbs. It may feel like your heartbeat is pulsing in your head. Other symptoms include:

  • Nausea
  • Throwing up
  • Light or sound sensitivity
  • Visual, speech, or sensory changes (aura)

Make a note of what you’re doing when you get a headache. You may be able to keep an attack from happening if you know what’s causing it. Certain factors may trigger either a migraine or cluster headache. These include:

  • Mental stress
  • Changes in your sleep routine
  • Too much alcohol
  • Bright light
  • Travel to high altitudes

Your doctor will likely approach each condition in a different way. You may need therapy to ease single attacks. That’s called acute or “rescue” treatment.

If you get headaches a lot, you may need medication to lessen how serious they are or how often you have them in the future. That’s called preventive or “prophylactic” treatment.

Treatment for migraine may include:

Over-the-counter medication. Painkillers like acetaminophen and ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs), may help with mild pain.

Injectables and nasal sprays. These drugs target brain chemicals and blood vessels that cause migraine pain and symptoms such as nausea. You can only get them with a prescription from your doctor. They work best when you take them at the start of your attack.

Preventive drugs. This is something your doctor might suggest if you have more than four migraine attacks a month. You may need oral drugs or shots.

Treatment for cluster headaches may involve a trip to the hospital. These headaches aren’t life-threatening, but the pain can be so bad that you need help right away.

You may need one or more of the following:

High-flow oxygen. This is usually the first thing your doctor will try, especially if you get more than one cluster headache a day. A health professional will have you breathe air through a facemask for 15 or 20 minutes. Sometimes you can get oxygen to use at home.

Sumatriptan shots. This drug goes directly under your skin. Compared to a pill, a shot works faster to target blood vessels and pain involved in a cluster headache.

Intranasal lidocaine. If oxygen and triptans don’t work, your doctor may spray this numbing agent up your nose.

Preventive drugs. You may need to take prednisone, a steroid, for a short while. It can lessen inflammation and swelling that leads to your headaches. Your doctor may give you other drugs that relax blood vessels or affect certain brain chemicals. Usually, verapamil, lithium, or topiramate.

There’s ongoing research into how best to treat cluster headaches. That includes certain kinds of nerve stimulation. You may have more choices in the future.

Let your doctor know about your headaches and all the symptoms that come with them. Treatment will help you feel better no matter what’s causing your head pain. Work with your doctor or a neurologist to find what’s best for you.