Prodromal and postdrome symptoms are key phases in the course of primary headache disorders, offering insights into pathophysiological mechanisms and guiding early intervention. Current research has predominantly focused on migraine, while studies on prodromal and postdrome features in tension-type and cluster headaches remain limited. This study provides reference for precise clinical diagnosis and treatment through comparative analysis.

To analyze differences between prodromal and postdrome symptom profiles among patients with migraine, tension-type headache, and cluster headache.

A total of 1 202 patients with primary headache were enrolled from the Headache Center of the Department of Neurology, Guizhou Provincial People's Hospital between March 1, 2022, and February 1, 2025. Demographic and clinical data were collected, and structured questionnaires were used to gather information on prodromal and postdrome symptoms. The 1∶2∶2 nearest neighbor propensity score matching (PSM) method was used to balance the baseline differences among patients with migraine, tension type headache, and cluster headache. Chi-square tests were used to compare symptom differences between groups after matching, with Bonferroni correction applied for multiple comparisons.

Among the 1 202 patients, 837 (69.6%) had migraine, 321 (26.7%) had tension-type headache, and 44 (3.7%) had cluster headache. Before matching, significant differences were observed in gender, age, education level, and current occupation across the three groups (P<0.05). After PSM, a balanced sample of 220 patients was obtained (44 with cluster headache, 88 with migraine, and 88 with tension-type headache), with no statistically significant differences in demographic characteristics (P>0.05). The male predominance in cluster headache remained unchanged after matching, and all covariates showed SMD<0.1, indicating successful baseline balancing. Migraine patients reported higher frequencies of fatigue, nausea, and photophobia/phonophobia as prodromal symptoms compared to those with tension-type headache (P<0.017). Cluster headache patients exhibited significantly higher rates of depressive symptoms during the prodrome phase than both migraine and tension-type headache patients (P<0.017). In the postdrome phase, migraine and cluster headache patients experienced higher frequencies of fatigue, difficulty concentrating, and dizziness compared to tension-type headache patients (P<0.017).

Migraine patients, burdened by more severe symptoms and greater functional impact, have higher healthcare utilization; their prodromal symptom profile is the most extensive, with nausea and sensory sensitivities being characteristic. Cluster headache stands out due to prominent depressive symptoms in the prodrome, and both migraine and cluster headache exhibit significantly heavier postdrome symptom burdens than tension-type headache. By adjusting for baseline confounders, this study provides a more accurate understanding of symptom profiles across different types of primary headache, offering robust evidence for comprehensive symptom management throughout the disease course.