Migraine vs Tension and cluster headache
How to tell Migraine and Tension and cluster headache apart when a board question makes them look alike.
Migraine is throbbing nausea/light sensitivity; tension is bilateral pressure; cluster is unilateral orbital autonomic pain.
Side by side
Migraine causes recurrent unilateral throbbing headache with nausea, photophobia, phonophobia, possible aura, and worsening with activity.
Tension headache is bilateral band-like pressure without major nausea or neuro aura; cluster headache is severe unilateral orbital/temporal pain with lacrimation, rhinorrhea, ptosis/miosis, or restlessness in clustered attacks.
Migraine involves trigeminovascular activation, cortical spreading depression in aura, and neuropeptide-mediated pain pathways.
Tension headache involves pericranial muscle/myofascial pain sensitivity; cluster headache is a trigeminal autonomic cephalalgia with hypothalamic timing and autonomic activation.
Normal neurologic exam between attacks with migraine phenotype supports migraine; imaging is reserved for red flags.
Bilateral pressing pain supports tension; short severe unilateral orbital attacks with ipsilateral autonomic signs support cluster headache.
The trap
All are primary headaches, so duration, autonomic signs, nausea/light sensitivity, and laterality decide the type.
The repair move
For primary headache, match pain quality and associated symptoms before naming the syndrome.
Try a free question
CoreA patient has recurrent unilateral throbbing headaches lasting hours, with nausea, photophobia, phonophobia, visual aura, and worsening with activity. Neurologic exam is normal between attacks. Which diagnosis is most likely?
Show answer and explanation
Answer: A. Migraine. Throbbing headache with nausea, photophobia, phonophobia, and aura supports migraine.
Why the other choices are tempting
- B. Tension headache is bilateral pressure without strong nausea or aura.
- C. Cluster headache is short severe unilateral orbital pain with autonomic signs.
- D. Subarachnoid hemorrhage causes thunderclap headache and meningeal signs.
- E. Trigeminal neuralgia causes brief electric facial pain triggered by touch.
Flashcards
Tap a card to flip it.
What symptom cluster points to migraine?
Unilateral throbbing headache with nausea, photophobia, phonophobia, and possible aura points to migraine.
What pain quality points to tension headache?
Bilateral band-like pressure points to tension headache.
Quick answers
What is the fastest way to tell Migraine from Tension and cluster headache?
Migraine is throbbing nausea/light sensitivity; tension is bilateral pressure; cluster is unilateral orbital autonomic pain.
What is the key clue for Migraine?
Migraine causes recurrent unilateral throbbing headache with nausea, photophobia, phonophobia, possible aura, and worsening with activity.
What is the key clue for Tension and cluster headache?
Tension headache is bilateral band-like pressure without major nausea or neuro aura; cluster headache is severe unilateral orbital/temporal pain with lacrimation, rhinorrhea, ptosis/miosis, or restlessness in clustered attacks.
What is the common trap with Migraine vs Tension and cluster headache?
All are primary headaches, so duration, autonomic signs, nausea/light sensitivity, and laterality decide the type.