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):… | Severe unilateral periorbital pain + ipsilateral autonomic features + restlessness, attacks clustered in time.; Excruciating ('worst pain imaginable,' 'ice… |
| 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,… | ICHD-3: ≥5 attacks, severe unilateral orbital/supraorbital/temporal pain lasting 15-180 min (untreated), with ≥1 ipsilateral autonomic feature OR sense of… |
| Imaging | Neuroimaging NOT routinely indicated for typical migraine with normal exam; MRI brain indicated for: red flags (SNOOP: Systemic symptoms/Secondary risk… | MRI brain with pituitary protocol recommended at least once for all patients with cluster headache to exclude structural lesion (pituitary tumor, carotid… |
| 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),… | 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… |
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