Migraine vs. Tension vs. Cluster: How to Tell Common Headaches Apart

An ache that starts like *this* might be a migraine.

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Everyone gets headaches once in a while. A mild headache that comes and goes is usually not a big deal, and the exact type of headache you’re having is probably not a huge concern. Riding it out or taking an OTC pain reliever may be the only action steps you need to do.

If headaches are plaguing you monthly, weekly, or daily, or if you’re feeling a pain you’ve never felt before, it may be time to investigate. Different types of headaches cause unique symptoms and may be triggered by different factors. That could be something as simple as hunger or as complex as your DNA.

“It’s important to get the right diagnosis of the type of headache you have,” says Mark Green, MD, neurologist at Mount Sinai Hospital in New York City. “The treatments are all quite different.”

Most headaches are caused by one of these three syndromes:  

  • Tension headache

  • Cluster headache

  • Migraine headache

What Are Tension Headaches?

Tension headaches are one of the most common types of headaches, and it earned its name due to its link to stress, according to the American Migraine Foundation (AMF). However, more recent evidence suggests there are additional causes beyond psychological. Learn more about common headache triggers here.

Tension headaches cause mild to moderate pain across the forehead or around the back of the head. They can last from 30 minutes to a week, and it’s not associated with other symptoms like nausea or aura.

“It’s usually a pressure-like pain,” says Dr. Green. “People [with tension headaches] self-treat and usually are fine.”

What Are Cluster Headaches?

Cluster headaches are more common among men than women, occuring at a ratio of 3:1, according to AMF. They’re considered the most painful of headaches, and patients sometimes describe it “as if a poker was put in my eye,” says Dr. Green.

During a cluster headache, pain is usually on one side of the face only and around one eye. Cluster headaches can build up quickly, in just a few minutes, but they can last up to two hours.

The term “cluster” refers to the repeated headache episodes over a period of weeks or months, separated by headache-free remission periods. To be classified as a cluster headache, however, it must affect the cranial nerve 5 (which triggers the localized pain around the eye) and cause other symptoms, like teary eyes, runny nose, and sweating.

What Are Migraine Headaches?

One of the common myths about migraines is that they’re just a “bad headache.” Migraine headaches are technically just one symptom of a complex migraine attack.

During a migraine attack, the person may go through multiple stages: prodromes, aura, migraine, and postdromes. This means there may be days or weeks before and after the actual migraine headache during which the person experiences unique, non-headache symptoms. Learn more about the symptoms of migraine at each stage.

Unlike other common types of headaches, migraines are accompanied by nausea and sensitivity to light and sound. In those who experience migraine with aura, they may also suffer from vision problems like blind spots, zig zags, and the appearance of “heat waves.”

It’s not just the symptoms of migraine that distinguish it from other headaches; people having migraines will also behave and react differently than those having a headache.

“In migraine, people want to go to bed. They want to hold still,” says Dr. Green. During a cluster headache, “people can’t hold still. They walk around, they pace, they bang their heads on the wall.”

If you experience migraines, you shouldn’t just muscle through them. “There’s evidence that migraines can be progressive, so the more you have, the more you’re going to get,” says Dr. Green. “People who have a significant amount of disability from migraines should try and seek medical care fairly early, and see if they can be reduced in frequency and in severity.”