How to distinguish between episodic migraine tension type and cluster headache
| Feature | Episodic Migraine | Episodic Tension Type | Episodic Cluster |
|---|---|---|---|
| Epidemiology | • 18% of women • 6% of men • 4% of children before puberty | • 90% of adults • 35% of children aged 3-11 years | • 0.4% for men • 0.08% for women |
| Female/male | • 3/1 after puberty • 1/1 before puberty | 5/4 | 1/5 |
| Family history | 80% of first-degree relatives | Frequent | Rare |
| Typical age at onset | • 92% before age 40 • 2% after age 50 | 20-40 | 20-40 |
| Visual aura | In 30% | No | Occasional |
| Location | • Unilateral, 60% • Bilateral, 40% | Bilateral > unilateral | Unilateral maximal orbital, supraorbital, and/or temporal |
| Quality | Pulsatile or throbbing in 85% | Pressure, aching, tight, squeezing | Boring, burning, or stabbing |
| Severity | Mild to severe | Mild to moderate | Severe |
| Onset to peak pain | Minutes to hours | Hours | Minutes |
| Duration | • 4-72 hours • 2-72 hours in children | Hours to days | 15-180 minutes |
| Frequency | Rare to frequent | Rare to frequent | 1-8 per day during clusters |
| Periodicity | Menstrual migraine | No | Yes. Average bouts 4-8 weeks Average 1 or 2 bouts yearly |
| Associated features | • Nausea in 90% • Vomiting in 30% • Light and noise sensitivity in 80% | Occasional nausea | • Ipsilateral conjunctival injection and/or lacrimation in 95% • Nasal congestion and/or rhinorrhea in 77% • Ptosis and miosis in 30% • Eyelid edema in 21% |
| Triggers | Present in 85% | Stress, lack of sleep | Alcohol, nitrates |
| Behavior during headache | Still, quiet, tries to sleep | No change | Often paces |
| Awakens from sleep | Can occur | Rare | Frequently |
Sources
- Evans RW: Diagnosis of headaches. In: Evans RW, Mathew NT, eds: Handbook of Headache. 2nd ed. Philadelphia: Lippincott, Williams & Wilkins, 2005, pp. 14-15.
- Huda W: Radiation risks: what is to be done? Am J Roentgenol 204(1):124-127, 2015
