Migraine vs Cluster Headache
Migraine and Cluster Headache are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Migraine vs Cluster Headache at a glance
- Migraine: Recurrent primary headache disorder with unilateral throbbing pain, photophobia, nausea.
- Cluster Headache: Severe unilateral periorbital headache with ipsilateral autonomic features; 'suicide headache.'
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Side-by-side comparison
| Feature | Migraine | Cluster Headache |
|---|---|---|
| At a glance | Recurrent primary headache disorder with unilateral throbbing pain, photophobia, nausea. | Severe unilateral periorbital headache with ipsilateral autonomic features; 'suicide headache.' |
| Classic presentation | POUND mnemonic: Pulsatile, One-day duration (4-72 h), Unilateral, Nausea, Disabling — 4 of 5 features highly suggest migraine.; Prodrome (hours-days before): mood changes, food cravings, neck stiffness, yawning, urinary frequency; Aura (~25%): visual (scintillating scotoma, fortification spectra, hemianopia), sensory (paresthesias… | Severe unilateral periorbital pain + ipsilateral autonomic features + restlessness, attacks clustered in time.; Excruciating ('worst pain imaginable,' 'ice pick in the eye') unilateral periorbital/temporal pain; Duration 15-180 minutes per attack; Frequency: 1 every other day to 8 per day, often at the same time(s) daily; Cluster… |
| Workup / key labs | ICHD-3 criteria: ≥5 attacks lasting 4-72 hours, with ≥2 of [unilateral, pulsating, moderate-severe, aggravated by activity] AND ≥1 of [nausea/vomiting, photophobia + phonophobia].; Generally not indicated for typical migraine; ESR/CRP if temporal arteritis suspected (age >50); CBC, BMP if atypical features | ICHD-3: ≥5 attacks, severe unilateral orbital/supraorbital/temporal pain lasting 15-180 min (untreated), with ≥1 ipsilateral autonomic feature OR sense of restlessness, occurring once every other day to 8 per day.; Not typically helpful for diagnosis |
| Imaging | Neuroimaging NOT routinely indicated for typical migraine with normal exam; MRI brain indicated for: red flags (SNOOP: Systemic symptoms/Secondary risk factors, Neurologic signs, Onset sudden/thunderclap, Older age >50 with new headache, Pattern change/Progressive/Positional/Precipitated by Valsalva); Lumbar puncture if SAH or… | MRI brain with pituitary protocol recommended at least once for all patients with cluster headache to exclude structural lesion (pituitary tumor, carotid lesion, AVM); Consider MRA if dissection suspected |
| First-line treatment | Abortive: NSAIDs (ibuprofen 400-800 mg, naproxen 500 mg) for mild-moderate attacks; Triptan — sumatriptan 50-100 mg PO (also 6 mg SC, 20 mg nasal), rizatriptan 10 mg, eletriptan 40 mg — best taken at headache onset; contraindicated with CAD, uncontrolled HTN, prior stroke, hemiplegic/basilar migraine, ergot use within 24 h; Combination… | Acute (abortive): high-flow 100% oxygen 12-15 L/min via non-rebreather mask for 15-20 min (works in ~70%, no contraindications); Triptan — sumatriptan 6 mg SC (most effective formulation) or 20 mg intranasal, zolmitriptan 5-10 mg nasal — faster routes preferred because attacks are short; Avoid oral triptans (too slow); Intranasal… |
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