Headaches
Approach to headaches
| Migraine | Cluster | Tension | |
|---|---|---|---|
| Sex predilection | Female > male | Male > female | Female > male |
| Family history | Often present | ± | None |
| Onset | Variable | During sleep or similar timing daily | Under stress |
| Location | Often unilateral | Behind one eye | Band-like pattern around the head (bilateral) |
| Character | Pulsatile & throbbing | Excruciating, sharp & steady | Dull, tight & persistent |
| Duration | 4-72 hr | 15-180 min | 30 min to months/years |
| Associated symptoms | Photophobia, phonophobia & nausea, ± aura | Ipsilateral autonomic symptoms: Ipsilateral sweating, facial flushing, nasal congestion, pupillary changes & lacrimation | Muscle tenderness in the head, neck, or shoulders |
Migraine
Cluster headache
- Quickly developing (within minutes), short, recurring attacks that usually occur in a cyclical pattern (“cluster periods”)
- May become chronic (less common), with interruptions of less than three months between cluster bouts
- Attacks often wake patients up during sleep.
- This clustering may suggest involvement of the hypothalamus, which regulates circadian rhythms.