Do I have Migraine, Tension, or Cluster Headaches?

Everyone has struggled with headaches at some point in their lives, if not they are a liar or incredibly blessed when it comes to genetics!

Whether it is the cancer patient with a brain tumor or the young college student after a night of binge drinking, headaches are among the common medical issues in the world.

According to the World Health Organization, It has been estimated that almost half of the adult population have had a headache at least once within the last year. Headaches, whether migraines, tension, or cluster, are the most common neurological disorder that is encountered in the health field.

As a Family Medicine physician, I can easily vouch for the number of headache patients. I have treated headaches caused by depression, stress, and migraines. I have also treated people who had headaches that were caused by something else like medication misuse or an ear infection.

To make it simplier, I will focus on a few types of headaches.

Migraines are the ones that can last a lifetime that is common in young women. They are a throbbing sort of headache with other symptoms like light sensitivity, nausea, and vomiting.

Cluster headaches are the most painful and usually affect men. These headaches affect the head, face, and eye of one side that can hit a person in “clusters” and then be headache free for a while.

Tension headaches are the most common type of headaches that are usually caused by some other factors like stress, muscle spasms, excessive smoking caffeine, or drugs. This is a dull type of headache that is the easiest to manage.

I will focus on these, as they are the Big 3 of headaches.

In this article, I will explain the causes and symptoms of the most common types of headaches so you can determine if your headache is something that a doctor needs to evaluate or not.

The Big 3 of Headaches


Migraines (Chronic, Can last a lifetime)

These are the most talked about headaches but not the most common. According to the World Health Organization, it is estimated that 30% of all headaches are migraines.

These headaches affect females (ages 20-40) 2x as much as males. These headaches are an organic neurological disease that can be debilitating.

That being said, these headaches are very treatable and very common just make sure you are working with your primary care physician or neurologist with this.


  • One side of the head
  • A pulsating or throbbing type of pain
  • Nausea and vomiting
  • Increased sensitivity to light
  • Aura (seeing flashing lights, odd patterns, feeling weird sensations, or difficulty speaking)
  • Lasts from hours to days
  • Fatigue
  • Mood changes


  • Bright lights
  • Loud sounds
  • Hormonal imbalances
  • Dehydration/malnutrition
  • Medications: oral contraceptives, blood pressure meds
  • Drug and tobacco use


  • Prophylaxis medications to prevent headaches like triptans and beta blockers
  • Lifestyle modifications like avoiding alcohol and smoking
  • Getting proper sleep
  • Treating the underlying condition of your migraines
  • Holistic methods like acupuncture, yoga, and meditation

Cluster (From Hours to Months, then Headache free periods)

Cluster headaches sound like what they are. They are headaches that can come on for a few minutes up to a few months.

These “clusters” of headaches are one of the most painful headaches one can have and I have been told it feels like “someone is stabbing me in my eye” according to some patients.

These headaches can occur at any age but typically affects men 2x as much as women.

Most people with these headaches that last a while will go to the ED for treatment due to the severity of pain.


  • Focused around one eye with radiation to one side of the head
  • A severe throbbing/stabbing type of pain that comes quick

"Important! If you feel a very severe headache that comes very quickly make sure you go to the ED to make sure you are nothing having a “thunderclap” headache which is a sign of deep brain bleed."

  • Eye tearing/redness or a runny nose
  • Sensitivity to light
  • Nausea and vomiting
  • Facial redness


  • The exact cause of cluster headaches is unknown, but it is generally not associated with triggers like migraine or tension headaches.
  • The cause of these headaches is due to the dilation of blood vessels to the head and face. Because these blood vessels are widened, there is pressure put on cranial nerve 5 (Trigeminal nerve- controls many motor and sensation functions of the face and head) thus causing pain.
  • Dysfunction of our hypothalamus (controls or biological clock and manages hormones) is also thought to play a role in cluster headaches.
  • Dysregulation of other neurotransmitters like histamine and serotonin are also thought to play a role.


  • Oxygen mask therapy w/ 100% O2 is the mainstay treatment for cluster headaches
  • Medications for acute headaches like NSAID’s and Tylenol
  • Medications that constrict blood vessels like triptans and dihydroergotamine
  • Preventative medicines like beta blockers, ergotamines, anti-depressant or anti-seizure medications can be used

Tension (Usually last minutes to days)

The most common type of chronic headache globally. According to the Cleveland Clinic, chronic headaches affect about 3 percent of the U.S. population.

These headaches are milder without the severe pain as cluster headaches or nausea and vomiting as with migraines.

The keyword with this type of headache is tightness.

Most people describe this type of headache is often described as tightness or pressure and can be related to musculoskeletal problems rather than organic neurological disease.

Due to this, avoiding stressors are crucial to avoiding tension headaches.


  • Sensitivity to light and noise
  • Pressure around head
  • Muscle spasm of your neck or head muscles
  • Usually dull to mild pain but can be severe


  • Excess screen time
  • Eye-straining
  • Smoking
  • Excess caffeine
  • Illicit drug use
  • Stress
  • Colds or infections
  • Poor sleep habits
  • Medications like stimulants and some blood pressure medications


  • Over the counter medications like NSAID’s (Ibuprofen, Motrin, Mobic, Ketorolac), muscle relaxants, and Tylenol

" Be careful! Using too much NSAID’s can actually lead to what is called “rebound” headaches. So, make sure to only use pain medication as needed for your headache"

  • Massage and physical therapy if the cause of your headache is due to musculoskeletal problems. It can also help reduce stress
  • Preventative medicines like triptans
  • Managing your stress by ensuring the proper amount of sleep and proper diet.
  • Also, address the causes of your stress by using stress management exercises or seeking out a therapist.

Final Words

  • If you are having a severe headache or chronic headaches, please get a medical professional to evaluate you. Other more serious causes of headaches include tumors, stroke, and brain bleeding.
  • Headaches can affect your quality of life so make sure you address this issue. No one wants to miss out on sports, a restful night’s sleep, or being productive in life due to headaches.
Christian Bramwell

Author BIO


Christian Bramwell, MD uses his own weight loss story as teaching for people struggling with their own weight through blogging, teaching, and writing. His mission in life is to promote health and education, that is why he has chosen to be a family physician and found his own nonprofit Project RAK based on education and empowerment.

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