Cluster vs. Tension Headache: How to Identify the Difference

Did you know that over 50% of the world’s population suffers from an active headache disorder? These disorders are conditions characterized by recurrent headaches.

There are several types of headaches, one of which is a tension-type headache (TTH). You may also hear people refer to it as a tension headache.

Then, there’s a cluster headache, which is rarer than TTH but much more painful. Indeed, sufferers rate cluster headaches as far more intense than other painful conditions. They say it’s more debilitating than labor pain, pancreatitis, and nephrolithiasis.

So how exactly do cluster vs. tension headache disorders differ? What are their symptoms, and how do you identify which one you have? Most importantly, how do you treat them?

This guide addresses all those questions, so read on.

Differentiating Cluster vs. Tension Headache Disorders

Headache location is one of the ways to distinguish a cluster from a tension headache. How the “pain” feels, where it spreads, and the accompanying symptoms can also help you tell which one you have. They also differ in how long they last, how often they occur, and what can trigger them.

Headache Location

A cluster headache usually affects the area around, behind, or in one eye. So if you have a one-sided headache primarily from one eye, you likely have a cluster headache.

If you have TTH, you may feel pain all over your head, not just at one specific point or side.

What the Pain Feels Like

A cluster headache is often excruciating. It can make you think it’s the worst headache you’ve ever had.

The pain of a tension headache is like a dull, pressure-like feeling. It feels like you have a tight band around your head.

Pain Progression

Another way to identify cluster vs. tension headaches is through their pain progression. With cluster headaches, the pain can radiate to the face, head, neck, and shoulders. As for tension headaches, the pain often starts at the temples but can be worse in the scalp or the back of the neck.

Accompanying Symptoms

Cluster headaches can cause swelling, redness, and excessive tearing in the affected eye. They may also sometimes cause the affected eye’s eyelid to droop. You may even develop a runny or stuffy nose, but only on the affected side.

Another accompanying symptom of cluster headaches is sweating on the affected side. You may notice this on your forehead or face.

Pallor or skin paleness during a cluster headache attack may also occur. However, some people may experience facial flushing instead.

Tension headaches have fewer accompanying symptoms, such as tenderness in the scalp. This unpleasant sensation may also affect the neck or shoulder muscles.

Duration and Frequency

Cluster headaches can occur in bouts of frequent attacks, known as “cluster periods.” These can last for weeks, even months. However, a remission period often follows, wherein no headaches occur.

A cluster headache can last 15 minutes to three hours during cluster periods. The headaches also often occur at night, typically one to two hours during bedtime. The attacks also usually happen daily and at the same time.

How long and often tension headaches occur depends if they’re episodic or chronic. Episodic tension headaches can last from half an hour to an entire week. However, they usually happen just 15 days (or fewer) a month for up to three months.

Unfortunately, frequent episodic tension headaches could progress to chronic TTH.

Each chronic tension-type headache attack can last continuously for hours. They also occur at least 15 days a month for at least three months.

Triggers or Contributing Factors

Cluster headaches have an unknown cause or origin. They also typically have no associated triggers. However, alcohol consumption during a cluster period may trigger or worsen an attack.

Stress can trigger or exacerbate tension headaches. Other contributing factors are glare, noise, and fatigue.

Treating and Preventing Cluster Headaches

Cluster headaches aren’t curable, but they’re manageable and treatable. Treatments aim to reduce pain severity and shorten each attack’s duration. Some methods may also help suppress future attacks.

After diagnosing cluster headaches, your doctor may prescribe the following:

• Oxygen
• Triptans, including sumatriptan or zolmitriptan
• Local anesthetics, such as lidocaine

The above are acute treatments, meaning they work fast.

Your doctor may also start you on a preventive treatment to suppress future attacks. It may include calcium channel blockers, corticosteroids, and nerve blockers.

Treating and Preventing Tension Headaches

Like cluster headaches, there’s no known cure for tension headaches. However, treatments exist to help reduce their intensity, duration, and frequency.

Over-the-counter pain relievers, like aspirin, ibuprofen, and naproxen, can help reduce TTH pain. However, combination medications, like aspirin and a sedative drug, may work better.

If you experience episodic TTH and migraines, see a headache specialist. The doctor may have to prescribe triptans, which can ease both headache types.

Also, remember that tension headaches can occur continuously for hours on end. This can lead to you suffering all day at work.

In that case, it may be in your best interest to see if there are TTH doctors near your job. You can look for headache specialists in this area with a quick online search.

Your headache specialist may also put you on a preventive treatment program. It may include prescription medications, like tricyclic antidepressants such as amitriptyline and protriptyline. Your doctor may also prescribe anticonvulsants and muscle relaxants.

It may also be helpful to identify and avoid your stressors. After all, stress can trigger or worsen tension headaches.

Likewise, determine and stay away from your TTH triggers. For example, if you think noise brings on an attack, use earplugs, ear muffs, or headphones to see if they can help.

If glare is your trigger, use blinds, curtains, or shades to reduce glare from windows. You can also use light diffusers or filters. Outdoors, make it a habit to don sunglasses, preferably polarized ones.

Address Your Headache Disorder ASAP

Now you know that location and intensity differentiate cluster vs. tension headache disorders. They also differ in accompanying symptoms, duration, and frequency.

So the next time you get an attack, use what you learned in this guide to help you determine which one you have. However, it may be best to see a specialist ASAP, especially if you’ve had headaches for a long time. The sooner you do, the sooner the expert can help address your symptoms.

For more headache guides, see our detailed post about the most common triggers to avoid!