Living with severe headaches is frustrating enough without trying to decode which type of attack you’re dealing with. Cluster headache and migraine attacks are both intense, both debilitating, and both often mislabelled. However, they’re actually two distinct primary headaches, recognised by the International Headache Society’s Headache Classification Committee, with different symptoms, attack duration, risk factors, triggers and treatment considerations.
This guide unpacks the key differences and the most important warning signs. It then shows how the team at Gold Coast Headache & Migraine Clinic™ supports people who experience headaches multiple times a week or several times a day.
If you’ve been stuck between “Is this migraine pain?” and “Is this a cluster headache?”, you’re in the right place.
What Is a Migraine?
Understanding Symptoms, Pain & Patterns
Migraines are one of the most common headache disorders globally, and they present very differently from cluster headaches. In fact, modern research now recognises migraine as a complex neurological disorder of sensory processing.
Migraine Symptoms
A migraine attack typically involves:
- Throbbing pain or pulsating pressure
- Pain on one side of the head, though it can shift or spread
- Sensitivity to light, sound or smell
- Nausea or vomiting
- Visual disturbances such as flashing lights, zigzags or blurred patches
- Neck pain and stiffness
- Sensory disturbances like tingling or numbness
- Difficulty concentrating
Many patients also notice early warning signs (a prodrome) like food cravings, irritability or fatigue hours before the migraine attack hits.
How Long Does a Migraine Last?
Migraines can drag on for 4–72 hours, especially without acute treatment. Many sufferers experience recurring or frequent attacks that impact work, sleep and overall wellbeing.
Chronic Migraine
When headaches occur on 15 or more days per month, the condition is classified as chronic migraine. These patients often experience a mix of migraine and non-migraine days that blur together, creating an exhausting cycle.
Explore migraine headache treatment
What Is a Cluster Headache?
Features, Severity & Attack Behaviour
Cluster headaches sit on the more extreme end of the headache spectrum. They’re brutally intense, short in duration, and strike with frightening reliability. They fall under the group of disorders known as trigeminal autonomic cephalgias, which helps explain their defining features: intense pain + cranial autonomic symptoms.
Cluster Headache Symptoms
Cluster headache patients often report:
- Excruciating pain around or behind one eye
- A burning or stabbing sensation
- Pain that stays on the same side of the head
- Red, watery eyes
- Facial sweating
- Runny or blocked nose (nasal congestion)
- Drooping eyelid or swelling
- Restlessness or inability to stay still
This is the polar opposite of migraines, where people tend to want quiet, dark rooms.
Attack Duration & Frequency
Cluster headache attacks usually last:
- 15–180 minutes
But the catch is how often they occur:
- Multiple attacks per day
- Often at the same time each day or night
- Frequently waking sufferers from sleep
Cluster Periods
Most sufferers experience “cluster periods” that last weeks to months, followed by pain-free periods (remission). This is called episodic cluster headache.
If attacks continue without meaningful remission for more than a year, it becomes chronic cluster headache (chronic CH).
Risk Factors
Cluster headaches have known associations with:
- Family history (familial cluster headache)
- Men, more commonly than women
- Disrupted circadian rhythms
- Higher alcohol sensitivity during a cluster period
Discover cluster headache treatment options
Migraine vs Cluster Headache – Key Differences
Both conditions involve severe head pain, but the patterns, sensations and associated symptoms make them completely different experiences.
Pain Type
- Migraine: throbbing pain, pulsating, often worsened by movement
- Cluster headache: sharp, stabbing, burning sensation behind one eye
Attack Duration
- Migraine: hours to days
- Cluster headache: short attacks, but extreme
Attack Frequency
- Migraine: typically once every few days or weeks
- Cluster headache: multiple attacks per day, sometimes 8+
Associated Symptoms
- Migraine: sensory disturbances, visual disturbances, nausea, aura
- Cluster headache: cranial autonomic symptoms (red eye, runny nose, facial sweating, drooping eyelid)
Behaviour During Pain
- Migraine: stillness helps ease migraine pain
- Cluster headache: patients pace, rock, or apply pressure due to extreme discomfort
Triggers
- Migraine: stress, hormonal fluctuations, sensory overload, poor sleep
- Cluster headache: alcohol during cluster periods, disrupted sleep, circadian rhythm changes
Why These Conditions Are Often Confused
High-intensity head pain makes it difficult to self-diagnose, especially when:
- Migraines can cause nasal congestion, mimicking cluster headache symptoms
- Cluster headaches may involve neck pain, often associated with migraine
- Both conditions involve the trigeminal nerve, which drives a lot of facial and head pain
- Some patients report symptoms overlapping with sinus headache or other headache disorders
Because overlapping symptoms are common, getting an accurate diagnosis from experienced healthcare providers is essential.
Conventional Treatment Options – What Most People Try First
Most people begin with standard medical treatments, but the results are often mixed.
Migraine Treatment Options
- Nonsteroidal anti-inflammatory drugs
- Triptans
- Anti-nausea medication
- Preventive medications (beta blockers, anti-seizure drugs)
- Lifestyle modification, sleep support, stress reduction
Cluster Headache Treatment Options
- High-flow oxygen for rapid pain relief
- Triptan injections or nasal sprays
- Preventive therapy, such as verapamil or corticosteroids
- Nerve blocks in stubborn cases
These can reduce symptoms, but they don’t necessarily address the underlying dysfunction that drives recurring attacks.
Our Approach – Treating the Root Cause, Not Just the Pain
At Gold Coast Headache & Migraine Clinic™, we focus on something most conventional treatments overlook: the link between upper cervical spine dysfunction and a sensitised brainstem.
Modern research indicates that:
- Dysfunction in the upper cervical spine can sensitise the brainstem
- A sensitised trigemino-cervical nucleus can misinterpret normal signals as threats
- This neural hypersensitivity can trigger migraine attacks and cluster headache attacks
- Referred pain patterns can mimic all the symptoms of migraine and cluster headache
By assessing the neck joints, the trigeminal nerve pathways and brainstem sensitivity, we can determine whether these structures are contributing to your symptoms.
Our treatment approach is:
- Non-invasive
- Medication-free
- Safe and targeted
- Designed to reduce attack frequency and intensity
- Effective for 85–90% of suitable patients, often within the first five to six sessions
We aim to help you manage headaches more effectively and prevent future attacks.
Learn more about our treatment approach
When Should You Seek Help?
You should book a proper assessment if you experience:
- Severe pain that feels out of proportion
- Attacks that occur repeatedly at the same time
- Unilateral eye pain with autonomic symptoms
- Recurring migraine attacks despite treatment
- Visual disturbances, sensory disturbances, or new warning signs
- Headaches that happen multiple times a day
- Any sudden change to your usual headache pattern
Persistent or escalating headaches are not something you should simply “push through”.
What to expect during an assessment
Book an Appointment at Gold Coast Headache & Migraine Clinic™
If these symptoms sound all too familiar, our clinicians can help you get clarity, an accurate diagnosis and a treatment pathway that targets the root cause, not just temporary pain relief.
With world-leading assessment methods and a medication-free approach, many of our patients see meaningful improvements within just a few sessions.
Book your initial consultation today and start taking control of your headaches.
Cluster Headache vs Migraine – FAQs
Are migraines and cluster headaches related?
They’re both primary headaches affecting the trigeminal nerve pathways, but they’re classified as distinct headache disorders with different attack patterns, symptoms and treatment options.
Do cluster headaches cause visual aura?
Not usually. Aura is far more common in migraine attacks. Cluster headache symptoms tend to involve autonomic signs like tearing, a runny nose and facial sweating.
Why do cluster headache attacks happen at the same time each day?
Cluster headaches have a strong link to the circadian rhythm and the hypothalamus, which explains their predictable timing.
Can a migraine feel like a sinus headache?
Absolutely. Many people mistake migraine for sinus headache due to overlapping symptoms like facial pressure, nasal congestion or runny nose.
What’s the fastest-acting treatment for a cluster headache attack?
For many cluster headache patients, high-flow oxygen provides the fastest relief, along with certain forms of acute therapy like injectable triptans.
Can neck issues trigger migraine or cluster headache symptoms?
Yes. Cervical spine dysfunction can sensitise the brainstem, increase trigeminal nerve activity and produce symptoms that mimic migraine or cluster headache patterns.
References
Goadsby, P.J. et al. (2017) ‘Pathophysiology of migraine: A disorder of sensory processing’, Physiological Reviews, 97(2), pp. 553–622. doi:10.1152/physrev.00034.2015.
Headache Classification Committee of the International Headache Society (IHS) (2018) ‘The International Classification of Headache Disorders, 3rd edition (ICHD-3)’, Cephalalgia, 38(1), pp. 1–211. doi:10.1177/0333102417738202.
May, A. et al. (2018) ‘Cluster headache’, Nature Reviews Disease Primers, 4, p. 18006. doi:10.1038/nrdp.2018.6.
Robbins, M.S. et al. (2016) ‘Treatment of cluster headache: The American Headache Society evidence-based guidelines’, Headache, 56(7), pp. 1093–1106. doi:10.1111/head.12866.
Dodick, D.W. (2018) ‘Migraine’, The Lancet, 391(10127), pp. 1315–1330. doi:10.1016/S0140-6736(18)30478-1.
May, A. and Burstein, R. (2019) ‘Hypothalamic regulation of headache and migraine’, Cephalalgia, 39(13), pp. 1710–1719. doi:10.1177/0333102419877661.
Ashina, M. (2020) ‘Migraine’, The New England Journal of Medicine, 383(19), pp. 1866–1876. doi:10.1056/NEJMra1915327.
Evers, S. and May, A. (2022) ‘Treatment of cluster headache: Current status and future strategies’, The Lancet Neurology, 21(2), pp. 142–152. doi:10.1016/S1474-4422(21)00374-5.
Charles, A. (2018) ‘The migraine aura’, Continuum, 24(4), pp. 1009–1022. doi:10.1212/CON.0000000000000627.
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