Side by side comparison featuring migraine symptoms including right head pain, odor sensitivity, light sensitivity; left side featuring cluster symptoms including tearing eyes, running nose, hornet like eye pain

Migraine vs Cluster Headaches:  What’s the Difference?

I experience two primary headache disorders: migraine and trigeminal autonomic cephalgia (TAC). Migraine started developing when I was 10. I developed cluster headaches, a member of the TAC disorders, in my 30s. Having one primary headache disorder does not make you immune to all others, so it is possible to have more than one primary headache disorder. However, being diagnosed properly proved to be difficult. While it is difficult to manage two different primary headache disorders, it does lend to an interesting perspective!  If you wonder about the differences between the two, I may be able to shed some light.

My experience with migraine

I have classic migraine with and without aura.  I have the occasional complication of status migrainosus that lasts 2 weeks ending with a visit to an ER to break it.

What my pain feels like

When a doctor asks me to describe my pain, I have an unconventional answer. “It feels like I’ve been hit upside the head with a baseball bat.” My current neurologist chuckled at my description and said it is a rather accurate way of saying it. I don't feel the sharp pain of hit with a baseball bat, just the aftermath.

The behavior of my migraine pain

Migraine pain usually begins on the right side of my head; the longer it hurts, the more of my head that follows suit. The pain waxes and wanes over the hours.

Other symptoms

The only eye symptoms are a visual aura on some migraine attacks and always light sensitivity. I also experience sound and odor sensitivity. Nausea is my most hated symptom, even above the pain. The more hours and days my attack lasts, the more it feels debilitating. Falling asleep is difficult, but eventually, I can. Sometimes my migraine is gone when I wake up, other times it picks back up where it left off. I find myself wanting to take naps to escape the pain. In the day or so following a migraine, I am left with a “migraine hangover.”  This includes brain fog, body fatigue, and other symptoms.

Trigeminal autonomic cephalgia (TAC)

My cluster attacks are very different. Cluster headaches are a part of a primary headache disorder called trigeminal autonomic cephalgia. There are aspects that set this primary headache disorder separate from migraine. First, a cluster attack goes from 0-10 within a few minutes. I have classic cluster headache attacks, except I am chronic, meaning I have been in cycle since 2017. 85% of cases are episodic. My left eye gets red, droopy, and starts to water. My left nostril stuffs and begins to run. This is the autonomic part of the terminology. The pain strikes along the trigeminal nerve. Cephalalgia means head pain or headache.  Hence, trigeminal autonomic cephalalgia.

Cluster headaches

The pain in my eye quickly turns to constant stabbing; a very sharp, piercing pain. My grandfather described it as a hot poker being jabbed in his eye. That illustration makes a lot of sense to me. It also feels like a hornet is stuck in my eye socket and I can feel it’s stinger jabbing me in the eye over and over again.

Poll

Do you know the difference between migraine & cluster headache?

The length of a cluster attack

The cluster attack lasts 15 min to 3 hours. Unmedicated, mine last 2-2.5 hours. Then it vanishes! Typically I have 1-4 of these per day. They can occur day or night. My first attack begins at 2am

Bearing through an attack

The excruciating pain of an attack is beyond comprehension. While in attack, I will do anything to make it stop. I am restless, pacing, rocking, squeezing my head, and more.  When not in attack, I will do anything to avoid feeling that ever again.

Cluster shadows

Cluster is not only about an attack. I also experience cluster shadows. The shadows are signs that the beast is near. My left eye may get red and irritated, though the pain doesn’t escalate, but it feels as if it might any second. My trigeminal nerve may feel irritable as well. During this time, I don't feel well and am slower at my daily activities.

Conclusion

If I had to give an award to each disease I would choose these. Migraine wins longest duration. Cluster wins most intense pain.

Share your migraine and/or cluster attack symptoms to help others understand the debilitating natures of both!

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