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.