Tension-Type Headache vs Cluster Headache
Tension-Type Headache 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.
Tension-Type Headache vs Cluster Headache at a glance
- Tension-Type Headache: Most common primary headache; bilateral pressing/tightening, mild-moderate, no nausea.
- Cluster Headache: Severe unilateral periorbital headache with ipsilateral autonomic features; 'suicide headache.'
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Side-by-side comparison
| Feature | Tension-Type Headache | Cluster Headache |
|---|---|---|
| At a glance | Most common primary headache; bilateral pressing/tightening, mild-moderate, no nausea. | Severe unilateral periorbital headache with ipsilateral autonomic features; 'suicide headache.' |
| Classic presentation | Bilateral, non-throbbing, mild-moderate, without autonomic or migrainous features.; Bilateral 'band-like' pressing or tightening pain; Mild to moderate… | Severe unilateral periorbital pain + ipsilateral autonomic features + restlessness, attacks clustered in time.; Excruciating ('worst pain imaginable,' 'ice… |
| Workup / key labs | ICHD-3: ≥10 episodes lasting 30 min-7 days, with ≥2 of [bilateral, pressing/tightening, mild-moderate, not aggravated by activity] AND no nausea/vomiting AND… | ICHD-3: ≥5 attacks, severe unilateral orbital/supraorbital/temporal pain lasting 15-180 min (untreated), with ≥1 ipsilateral autonomic feature OR sense of… |
| Imaging | Not indicated for typical TTH with normal exam; MRI brain only if red flags (SNOOP — systemic, neurologic, onset, older age, pattern change) | 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 | NSAIDs — ibuprofen 400-800 mg, naproxen 500 mg — first-line for acute treatment; Acetaminophen 1000 mg — alternative; less effective than NSAIDs; Aspirin… | 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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