Debate: Are cluster headache and migraine distinct headache disorders?

Abstract

Cluster headache and migraine are regarded as distinct primary headaches. While cluster headache and migraine differ in multiple aspects such as gender-related and headache specific features (e.g., attack duration and frequency), both show clinical similarities in trigger factors (e.g., alcohol) and treatment response (e.g., triptans). Here, we review the similarities and differences in anatomy and pathophysiology that underlie cluster headache and migraine, discuss whether cluster headache and migraine should indeed be considered as two distinct primary headaches, and propose recommendations for future studies. Graphical Abstract Video recording of the debate held at the 1st International Conference on Advances in Migraine Sciences (ICAMS 2022, Copenhagen, Denmark) is available at https://www.youtube.com/watch?v=uUimmnDVTTE.

Fremanezumab and Non-High-Dose Galcanezumab for Comorbid Cluster Headache in Patients with Migraine: Three Cases

“…Differences and similarities have been reported between CH and migraine [ 21 ]. As to the differences, migraine mostly affects women (women to men ratio: 3:1), whereas CH is more common in men (men to women ratio: 4.3:1) [ 7 ].…”

“…There may be some commonality in pathophysiological pathways, but there are also significant variances, according to demographic, genetic and temporal trends. Common pharmacological triggers point to a shared anatomical and pathophysiological substrate, but as CH attacks are initiated more quickly than migraine attacks, the signaling cascades involved in attack initiation may vary [ 21 ]. Taken together, however, CGRP functional blockade may alleviate neurogenic inflammation and reduce pain pathway sensitization in both migraine and CH; considering this, CGRP may play an important role in CH.…”

“…CGRP-mABs are now widely used as epidemiological studies are conducted [ 15 ], and patient interest in treatment increases [ 16 ]. Considering that CH can be complicated by migraine headaches [ 17 ], that CGRP may relate to both CH and migraine [ 18 , 19 , 20 ], that trigger factors, such as alcohol, and treatment response to triptans are clinically similar [ 21 ], and that migraine headaches are accompanied by autonomic symptoms [ 4 ], CH and migraine headaches may overlap in their mechanism.…”

Reduced plasma calcitonin gene-related peptide level identified in cluster headache: A prospective and controlled study

“…Persons with episodic CH in bout and chronic CH both have similar attacks and are phenotypically similar (5). However, notable differences exist such as reduced effectiveness of medication and attack induction in chronic CH indicating separate states (3,6,7). These three disease states (i.e.…”

“…These three disease states (i.e. bout, remission and chronic) represent a clear clinical distinction from migraine (3), although the pathophysiological substrate for the three disease states in CH is currently unknown.…”