Curr Pain Headache Rep. 2007 Apr;11(2):154-7. 


Cluster-migraine: does it exist?

Applebee AM, Shapiro RE.

Given C219B, Department of Neurology, University of Vermont College of Medicine, 89 Beaumont Avenue, Burlington, VT 05405, USA. robert.shapiro@uvm.edu.

The nosological boundaries between cluster headache and migraine are sometimes ill-defined. Although the two disorders are distinct clinical entities, patients sometimes present with clinical scenarios having characteristics of both headache types, but either do not fully meet International Classification of Headache Disorders, Second Edition diagnostic criteria for either disorder or have sufficient symptoms and signs to allow both diagnoses to be present. These occasions provide diagnostic challenges and include what is variously described as migraine-cluster, cyclical migraine, clustering episodes of migraine, cluster with aura, or atypical cluster without autonomic symptoms or severe pain. Patients with symptoms overlapping cluster headache and migraine likely reflect the inherent clinical variability in each of these two disorders, rather than distinct diagnostic entities in their own right.

PMID: 17367596

I get and have been diagnosed with both. I have come to know each type of headache quite well, and for me the distinction is clearly defined. My CH will reliably hit at around 3:30 am, cause insane levels of pain for about 30 minutes, and be gone as soon as it came. No nausea, no worries about light or sound. Swollen eye, tearing, stuffy nose. Basically all of the classic signs and symptoms.

On days Mr. Migraine shows up, I have pain in the same area but it is more diffuse, less intense, but more persistent and throbbing. And I always get nausea with a migraine. Always. And they last for hours, sometimes a whole day.

Verapamil, Imitrex shots, oxygen, energy drinks, and running can all work for the CH. Migraine, on the other hand, demands regular Imitrex pills or various analgesics (and sometimes, Percocet)... and most importantly, Zofran for the endless puking.