Spending a bit of time on Twitter lately, I’ve noticed that there still seems to be quite a bit of confusion over what migraine is, as opposed to what cluster is.

Sometimes in the past the two have been used interchangeably. Or sometimes, just based on imprecise information. For example, sometimes people think of any bad headache as a "migraine headache", or think of certain types of pain as a "cluster headache".

In reality, these two are very different, and require different types of treatment. Let’s take a quick look at cluster and migraine, and see if we can clear up a few misconceptions.

Migraine vs Cluster

Migraine Cluster Similar Typically one-sided pain

pain Congestion a common symptom Different Pain usually moderate to severe

to Usually a throbbing pain (if headache is present)

pain (if headache is present) Often accompanied by headache

Common (about 16% have at least one migraine attack) Very Different Lasts 4 hours to 3 days

Symptoms may come on suddenly or gradually , and usually decrease gradually .

, and usually . Aggravated by activity (patients prefer to lie down in a dark room)

(patients prefer to lie down in a dark room) More common in women , but men get it too

, but men get it too Attacks may or may not have a predictable pattern . (ie patients may get one attack in a lifetime, or attacks on a monthly cycle, etc)

(ie patients may get one attack in a lifetime, or attacks on a monthly cycle, etc) Other typical symptoms: Auras (visual and otherwise), nausea, sensitive to light and/or sound Similar Usually one-sided pain

pain Congestion a common symptom Different Pain usually severe to very severe

to Usually a sharp, burning pain

pain Almost always accompanied by headache

Rare (present in about 0.3%) Very Different Lasts 15 min to 3 hours

Headache usually comes suddenly – may reach peak intensity in 5-10 min, and decreases rapidly

– may reach peak intensity in 5-10 min, and Patients restless and agitated during and attack (prefer to pace or rock back and forth)

during and attack (prefer to pace or rock back and forth) More common in men , but women get it too

, but women get it too Attacks come in a pattern or cycle : headache every other day up to 8 times a day (often the same time every day). Attacks occur in a series (cluster period) lasting for weeks or months, then a remission of months or years (some chronic sufferers have no remission periods)

: headache every other day up to 8 times a day (often the same time every day). Attacks occur in a series (cluster period) lasting for weeks or months, then a remission of months or years (some chronic sufferers have no remission periods) Other typical symptoms: watery and/or red eyes, sweat, swollen or drooping eyelid, congestion, small pupil

You’ll see right away that I used terms like "usually" and "typically" a lot, and I probably could have used them more. There is a lot of variation from person to person, so we’re just hitting on some of the more common, typical traits of each. But just a reminder – either of these can include pain that’s not just on one side, sometimes there is no pain in migraine, sometimes it’s not throbbing pain, etc.

Key differences

You can see highlighted some of the key differences between migraine and cluster. Cluster headaches come on faster and leave quicker than migraine attacks. It’s unusual for a migraine attack to last less than 4 hours, and unusual for a cluster attack to last more than 3 hours.

Another key difference – migraine patients tend to avoid light and movement. They’ll often go lie down in a dark room.

That’s the last thing a cluster patient wants to do – good luck getting them to lie down! They become restless and may rock or pace.

But the last highlighted item is especially key. Clusters get their name not from where the pain is or what it feels like, but from the cycles of pain.

You’re not going to get just one cluster headache. You’ll get several in a series – maybe one a day, or several a day, regularly. This can go on for weeks and even months, but then completely disappear for months or years.

Sad to say, there are also chronic cluster headache sufferers who have no periods of remission (as this recent news story on cluster headache illustrates).

Hopefully that clears up some misconceptions, especially regarding cluster. Cluster is an incredibly painful condition. There is treatment for cluster, but the treatment has had limited success in many people. Much more research needs to be done to fight what has been rightly called the suicide headache.