DEAR MAYO CLINIC: What’s the difference between a cluster headache and a migraine? Is there a way to treat severe headaches without prescription medication?

ANSWER: There are various differences between cluster and migraine headaches, including how long the headaches last, how often they occur and the area of the head they affect. Several options are available to treat these severe headaches without a prescription.

One of the defining differences between cluster and migraine headaches is their duration. A cluster headache lasts about 30 to 90 minutes. A migraine lasts longer — often the entire day or potentially several days if left untreated. While it’s uncommon to have more than one migraine a day, it’s possible to have up to eight cluster headaches in one day. With cluster headaches, there are pain-free periods between the headaches. Migraine headaches often fluctuate in severity over the course of one headache, but the pain doesn’t go away completely.

Migraine pain can vary in location — developing on just one side of the head, behind the eye, in the back or front of the head, or the pain may be felt throughout the entire head. Cluster headaches involve only one side of the head — typically at the temple or around the eye.

When a person has a migraine, it usually is soothing to rest with the lights off in a quiet room. In contrast, people who have cluster headaches usually become agitated. Other symptoms may accompany the head pain in both cluster and migraine headaches. Cluster headaches usually involve eye redness, tearing or nasal congestion on the side of the face where the headache is located. Migraine headaches may trigger nausea and vomiting.

There is some overlap between the two headache types, and that can make it hard to differentiate between the two. For example, some migraine headaches can cause tearing, eye redness and nasal congestion, too. But those symptoms usually involve both sides of the head with a migraine, rather than just one side, as with cluster headaches. The best features to use to separate the two are the duration of the headache, and the feeling of agitation or preference for rest.

Several techniques can be used to manage these headaches without a prescription. A nonsteroidal anti-inflammatory drug, or NSAID, such as ibuprofen or naproxen, can ease migraine pain. But don’t take NSAIDs if you are taking blood thinners, if you have a history of kidney problems, or if you have had gastric bypass surgery.

Be careful how frequently you take NSAIDs. If you take them too often, they can damage your kidneys or gastrointestinal tract. Do not exceed the dosing recommendations listed on the label. If taken more than 14 days a month, NSAIDs can worsen headaches.

If NSAIDs are not effective for a migraine, then a combination pain reliever that contains aspirin, caffeine and acetaminophen — such as Excedrin Migraine — can help. But those pain relievers can only be taken up to nine days a month.

Over-the-counter pain medications typically are not effective for cluster headaches. In some cases, melatonin may help ease cluster headache pain. Other supplements, including magnesium and riboflavin, have been used to help treat migraine headaches. But even when taken consistently, it usually takes about six months to notice any difference, and, in general, these supplements alone do not effectively curb headache pain. Talk to your health care provider before you take any supplements.

Exercise that elevates the heart rate for at least 30 minutes a day, three times a week, can reduce the severity and frequency of headaches. Some people also find using biofeedback techniques such as breathing exercises helpful.

If severe headaches are an ongoing problem that disrupts your daily life, make an appointment with your health care provider for an evaluation, and discussion of additional treatment and prevention strategies. — Dr. Narayan Kissoon, Neurology, Mayo Clinic, Rochester, Minnesota

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