Key clinical features that assist the differentiation of more common headache disorders
| Headache | Tension-type headache | Migraine | Trigeminal autonomic cephalalgias | Trigeminal neuralgia | |||
|---|---|---|---|---|---|---|---|
| Cluster headache | Paroxysmal hemicrania | Hemicrania continua | SUNCT/SUNA | ||||
| Sex (M:F) | 4:5 | 3:1 | 5:1 | 1:1 | 1:2 | 3:2 | 2:3 |
| Duration | 30 min to 7 days (episodic) | 4–72 h | 15–180 min | 2–30 min | Continuous headache | 1–600 s | 1–120 s |
| Frequency | Episodic or chronic (variable from rare to daily) | Episodic or chronic (variable from rare to daily) | 1–8/day | >5 daily for more than half of the time | Continuous headache | >1 daily for more than half of the time | Very variable frequency |
| Pain type | |||||||
| Location | Bilateral | Unilateral or bilateral | Unilateral | Unilateral | Unilateral | Unilateral; V1/V2>V3 | Unilateral; V2/V3>V1 |
| Quality | Pressing/tightening (non-throbbing) | Throbbing | Variable | Variable | Variable | Neuralgiform pain | Neuralgiform pain |
| Severity | Mild to moderate | Moderate to severe | Very severe | Very severe | Moderate to very severe | Very severe | Very severe |
| Migrainous symptoms | – | +++ | +/– | – | +/– | – | – |
| Autonomic features | No | +/– | +++ | +++ | +++ | +++ | Sparse |
| Triggers | Alcohol (within 30 min) | Cutaneous | Cutaneous | ||||
| Indometacin response | +/– (as simple analgesic) | ± (as simple analgesic) | – | +++ | +++ | – | – |
Based on framework of International Headache Society Classification Criteria.
Chronic migraine is defined as headache occurring on 15 or more days per month for more than 3 months, which has the features of migraine headache on at least 8 days per month. Chronic cluster headache and paroxysmal hemicrania are defined as headache attacks occurring for more than 1 year without remission or with remission periods lasting less than 1 month.
SUNA, short-lasting unilateral neuralgiform headache with cranial autonomic symptoms; SUNCT, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing.