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Table 2 Summary of features distinguishing the important primary headache disorders (NB: two or more of these disorders may occur concomitantly)

From: Aids to management of headache disorders in primary care (2nd edition)

  Migraine Tension type headache (TTH) Cluster headache (CH)
Temporal pattern Episodic migraine:
 Recurrent attack-like episodes, lasting from 4 h to 3 days; frequency often 1–2/month but variable from 1/year to 2/week or more; freedom from symptoms between attacks
Chronic migraine:
 Episodicity lost: headache on ≥15 days/month, having migrainous features on ≥8 days/month
Frequent episodic TTH:
 Recurrent attack-like episodes lasting hours to a few days; 1–14 days affected per month; freedom from symptoms between attacks
Chronic TTH:
 ≥15 days affected per month (often daily and unremitting)
Episodic CH:
 Frequent (typically ≥1 daily) short-lasting attacks (15–180 min):
  • Recurring in bouts, usually once or sometimes twice a year, which are typically of 6–12 weeks’ duration;
  • Then remitting for ≥3 months
Chronic CH:
 Similar, but without such remissions between bouts
Typical headache characteristics Often unilateral; often pulsating Can be unilateral but more often generalised; may spread to the neck; typically described as pressure or tightness Strictly unilateral (although side-shifts occur occasionally), around the eye or over the temple
Headache intensity Typically moderate to severe Typically mild to moderate Extremely severe
Associated symptoms Aura (in a minority of attacks); often nausea and/or vomiting; often photo- and/or phonophobia Frequent episodic TTH:
 None typical; mild photophobia or phonophobia may occur
Chronic TTH:
 Sometimes mild nausea, but not vomiting
Strictly ipsilateral autonomic features:
 • Any or all of red and/or watering eye, running or blocked nostril, ptosis
Reactive behaviour Avoidance of physical activity (maybe bed rest); preference for dark and quiet None specific Marked agitation: cannot lie still during attacks