Migraine or Cluster Headache?
Cluster headaches may be considered a type of migraine, but there are several important distinctions. As described in depth in Chapter 2, cluster headaches come in episodes, varying from a week to a year, while most migraines consist of a single episode. In addition, cluster headaches belong more to the realm of men. While less than 0.5 percent of the population suffers from cluster headaches, nearly 80 percent of those cases consist of men. Women can also have cluster headaches or cluster migraines, but they are in the minority.
How can men tell the difference between cluster headaches and frequent migraines? Because men are much more likely to suffer from cluster headaches than women, the temptation is to jump to a diagnosis of cluster headache. However, because some treatments for these types of headaches are not the same, it is critical to obtain a correct diagnosis.
Generally, the diagnosis must be made with the help of a detailed headache diary. Taking note of when headaches occur, and for how long, can be key in differentiating a cluster headache from a traditional migraine. Cluster headaches tend to appear in the middle of the night, for example, whereas traditional migraines do not. Cluster headaches can be gone in less than an hour, where a migraine generally lasts for much longer without the aid of abortive medication. Migraines often have warning signs and symptoms, where cluster headaches often appear to come “out of nowhere,” and they often arrive with a vengeance.
The location of headache pain tends to differ with clusters and migraines. Men experiencing cluster headaches often describe pain that occurs either behind or around one eye. Cluster headache pain is generally considered sharp, or stabbing. Migraine pain tends to be duller and more throbbing, and often spreads to the front or back of the head.
Ancillary symptoms are another important diagnostic tool. If a man suffers from headaches frequently and tends to have accompanying facial pain, particularly on one side or the other, cluster headaches may be more likely. Oftentimes, cluster headaches are accompanied by sinus headache, including nasal congestion, watering eyes, and facial puffiness. These symptoms tend to correlate less often with migraines.
Acute cluster headache treatment overlaps with acute migraine treatment; standard therapy includes triptan medication. There are also acute treatments that work more specifically on cluster headaches but are less effective on migraines. Intranasal lidocaine or capsaicin, for example, has been shown to be more effective on cluster headaches than migraine. In addition, oxygen therapy is a highly effective treatment for cluster headaches.
Cluster headaches may respond to some of the same preventative treatments as migraine headaches. Ergotamines are taken in the hour or so before a headache is expected to land with full force, and they work well for nighttime use. Valproic acid takes several days to work but is also effective as a prophylactic. Other remedies that are not necessarily beneficial for migraineurs can work well for cluster headaches. Prednisone is an oral steroid that works quickly, but has a variety of side effects such as weight gain and hyperglycemia (high blood sugar). Lithium is also highly effective in stopping cluster headache, but it also is associated with an array of troublesome side effects, including tremor, nausea, fatigue, weight gain, and potential kidney and thyroid problems.
The success of treatment can, in and of itself, be a factor in making a correct diagnosis. If oxygen therapy is successful, for example, there is increased evidence for the presence of a cluster headache as opposed to a traditional migraine.
