Migraine and cluster headache: coexistence, laterality, and gender.

CLINICAL HISTORY A 38-year-old woman reported a history of headache since aged 11 years, occurring about once a month. Triggers included stress and missing a meal, and she described a severe left or right hemicranial throbbing pain with associated nausea, vomiting, photophobia, and phonophobia, but no aura. Attacks lasted up to 3 days. An acetaminophen/aspirin/caffeine combination “dulled” the pain. For the last year, she had a second type of headache involving severe right or left retro-orbital pressure with ipsilateral tearing and nasal congestion. The headache would awaken her from sleep and occurred only around 3:30 AM. Headache duration was 60 to 90 minutes, and the frequency had decreased from daily to once a week over several weeks preceding her presentation. Questions.—How often do migraine and clustertype headache occur in the same individual? How often does unilateral migraine change sides, and how often is the headache side-locked? How often does cluster headache change sides within cluster periods, and how often does cluster headache change sides from one period to the next? What is the female to male ratio of cluster headache?