The Difference Between a Migraine and Cluster Headache

Terrible Headache

A lot of people in the UK and around the world suffer headaches on a daily basis. Most of these headaches are the new neurological symptom commonly seen by general practitioners and neurologists in the UK¹.

Thankfully cluster headaches are not a common headache to experience by most. Cluster headaches were termed the ‘suicide headache’ by American neurologist Dr. Bayard Horton. Remember though a cluster headache is not a migraine headache. So read on to find out more about cluster headaches.

Symptoms of a Cluster Headache

Cluster headaches, are classified as a primary headache disease. Cluster headache symptoms are identified as:

excruciating, one-sided, recurrent but short-lasting, pain around the eye region.

It is characteristically associated with ‘autonomic’ nervous system signs, such as tearing, nasal stuffiness, redness of the eye and occasionally, drooping of the eyelid and short-sighted vision. Young males are predominately affected with a ratio of 3:1 male to female.

Attacks usually occur on a daily basis, in clusters of 6-12 week periods, hence the name of ‘cluster’. Typically headache attacks are rapid onset, lasting from 30 mins to 2 hours. Attacks occur more commonly at night time, the most common times noted as 1a.m., 4a.m. and 7 a.m. Headache bouts may last from 6-12 weeks and then abate for long periods.

What Causes Cluster Headaches

Commonly cluster headaches occur around the same time each year. In the UK, the months of December, January and February appear to be the most provocative. The reason is yet unknown.

Alcohol is the most recognised trigger for cluster headaches. Although strong odours (cigarette smoke and solvents) and frequent napping, have also been noted as aggravators. However, when the bouts of headaches are not present it is not unlikely to find that these triggers may not be effective during this time.

What Does a Cluster Headache Feel Like?

The patient with cluster headaches usually recalls the symptoms of a rapid onset headache that starts with a tingling sensation around the eye and nostril. Within minutes these symptoms worsen to a severe pain, usually described as acid in the eye, or a hot poker put up the nose. The affected eye rapidly begins to water and turns bloodshot, with the nose becoming congested and a watery nasal discharge carrying on throughout the attack. Following each attack the eye and cheek feel bruised and tender. This feeling may persist until the next attack begins.

Treatment for a Cluster Headaches

Treatment for cluster headaches begins at an acute symptomatic level, trying to stop the pain, due to its severity. To date, no curative treatment exists. Evidence based guidelines for the treatment of cluster headaches have been developed by the European Federation of Neurological Societies (EFNS)².

Types of Cluster Headache Medication

Treatment to help the immediate cluster headache pain is typically the subcutaneous administration of the drug sumatriptan (serotonin agonist) and inhalation of high-flow oxygen. Prophylactic or preventative treatment to help decrease the length of the bout of cluster headache attacks typically revolves around the calcium channel blocker, verapamil, and administration of lithium, methysergide and prednisone.


  1. Latinovic R, Gulliford M, Ridsdale L. Headache and migraine in primary care: consultation, prescription, and referral rates in a large population. J Neurol Neurosurg Psychiatry. 2006 Mar;77(3):385-7.
  2. May A., Leone M., Afra J., Linde M., Sándor P.S., Evers S., Goadsby P.J. EFNS guidelines on the treatment of cluster headache and other trigeminal-autonomic cephalalgias. Eur J Neurol. 2006 Oct;13(10):1066-77.