Cluster Migraine Variant

So what is cluster migraine variant? Cluster migraine variant can be difficult to diagnose. Symptoms are mixed from cluster and migraine headache symptoms. This is a type of headache that is easily mistaken for just migraine as it has many of the symptoms similar to migraine alone.
Most patients will have severe unilateral or one sided head pain. The pain can be throbbing and occastionally stabbing. Most patients tell me that the light bothers their eyes but usually there is no nausea.

Interestingly..most migraineurs want to be in a quiet dark room and lie still.

Cluster headache patients prefer to move around to relieve pain. Since most doctors who are not neurologists are unaware of this they tend to misdiagnose cluster headaches and therefore REALLY misdiagnose cluster migraine variant.

I have a few of these patients so I should tell you that over all, this condition is quite rare. These types of headaches are a mixed syndrome and instead of lying down and being quiet, people want to walk around which is a cluster symptom.

Not everyone has the exact same set of symptoms in this type of headache which makes diagnosing even more difficult. The key is to LISTEN to the patient and spend some time sorting things out. This is where a good headache specialist really comes in handy!

Treatment of Cluster Migraine Variant

First of all, with this presentation of symptoms that appear mixed, we generally get an MRI done to rule out emergency causes of headaches.
Once those have been ruled out, treatment is similar to other headache treatment but may be tailored to each patients individual complaints.

If a patient has stabbing pain behind the eye (cluster) they may respond to Verapamil which is used to treat both cluster and sometimes migraine.

If nausea occurs (migraine) then I will give Compazine for nausea. By the way it treats headache too which many people are unaware of.

Sleep disturbances so common with any headache syndrome generally respond to low doses of Elavil.

All of these patients are put on the vitamin therapy that we recommend containing magnesium, B2 and feverfew. The vitamins generally treat the migraine end of the spectrum.

With proper treatment, these patients generally respond well. Some may require a short course of steroid to break the cycle of headaches as steroid will treat both migraine and cluster headaches.

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