VHOSPITAL.CLINIC · Differential Diagnosis
Cluster Headache vs Migraine
Clinical comparison — shared symptoms, key differences, distinguishing diagnostic tests, treatment pathways, and when to seek urgent evaluation.
Condition Overview
Condition A
Cluster Headache
Cluster headaches are one of the most painful conditions, causing severe unilateral pain around one eye, accompanied by tearing, nasal congestion, and restlessness. They occur in cyclical patterns (clusters) and respond to oxygen therapy and triptans.
Condition B
Migraine
Migraine is a neurological disorder characterized by recurrent, severe headaches often accompanied by nausea, vomiting, and sensitivity to light and sound. Attacks can last 4–72 hours and significantly impair daily functioning.
Shared Symptoms — Why They're Confused
Both conditions present with 1 overlapping symptom, making clinical differentiation essential.
Key Clinical Differences
Cluster Headache
- Severe unilateral headache
- Nausea (migraine > cluster)
- Photophobia (migraine)
- Episodic pattern
Migraine
- Unilateral, strictly periorbital, excruciating ('suicide headache')
- Autonomic features: lacrimation, rhinorrhoea, conjunctival injection
- Duration 15–180 minutes
- Patient is restless and agitated (unlike migraine patients who prefer darkness/rest)
Distinguishing Diagnostic Tests
| Test | Cluster Headache | Migraine |
|---|---|---|
| Clinical history + ICHD-3 criteria | Cluster: strictly unilateral periorbital, autonomic features, restlessness, duration 15–180 min | Migraine: moderate-severe throbbing, nausea/vomiting, photo/phonophobia, prefers rest, 4–72 hours |
| MRI brain | Normal (to exclude secondary causes) | Normal (to exclude secondary causes); may show cortical spreading activation |
| Response to oxygen therapy | High-flow 100% O2 aborts cluster headache in 15 minutes | No benefit from oxygen — does not respond |
Treatment Approaches
Cluster Headache
- •Acute: 100% O2 (12L/min, 15 min) + triptans SC/nasal
- •Preventive: verapamil, lithium, short-course prednisolone
Migraine
- •Acute: oral/nasal/SC triptans, NSAIDs, antiemetics
- •Preventive: topiramate, amitriptyline, beta-blockers, CGRP antagonists
When Doctors Consider Each Diagnosis
🔵 Consider Cluster Headache when:
- →Strictly periorbital unilateral pain, autonomic features, restlessness, responds to oxygen
🟢 Consider Migraine when:
- →Throbbing unilateral or bilateral headache with nausea/aura, patient lies still, lasts 4–72 hours
Explore Each Condition in Detail
Related Clinical Pages
Cluster Headache
Medical References
Content on this page is informed by evidence-based clinical sources including:
- World Health Organization (WHO)Global health guidance and disease classification
- National Health Service (NHS)UK clinical guidelines and patient information
- National Institute for Health and Care Excellence (NICE)Evidence-based clinical practice guidelines
- Centers for Disease Control and Prevention (CDC)US public health data and clinical recommendations
- PubMed – NCBIPeer-reviewed biomedical literature and clinical studies
- Cochrane LibrarySystematic reviews and meta-analyses in evidence-based medicine
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