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 |