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State and Trait Anger in Migraine vs Cluster Headache

Patients with migraine and patients with cluster headache (CH) differ in state anger, indicating that CH patients experience higher intensity on anger during the time of testing, a new study found. 135 migraine and 108 CH patients completed the State Trait Anger Expression Inventory, composed of 7 subscales. Researchers found:

  • Patients with CH have higher median scores than patients with migraine in state anger.
  • Patients with CH also have lower scores in anger control out.
  • In subgroup analysis, patients with CH during the cluster period have higher scores than chronic migraine patients in state anger, while patients with CH in headache-free period did not different from patients with migraine.


Rausa M, et al. State and trait anger and its expression in cluster headache compared with migraine: A cross-sectional study. [Published online ahead of print June 28, 2019]. Neurol Sci. doi: 10.1007/s10072-019-03987-0.


It often takes years for a cluster headache patient to receive the correct diagnosis, and inadequate treatment of cluster headache is common. The clinical milieu that a cluster patient encounters can be poor. Add to that the severity of cluster headache pain, and anger, desperation, depression, and anxiety become understandable pain accompaniments. In addition, the investigators note that anger can influence the perception of pain. They also found that cluster headache patients appear to feel more anger in the cluster period than they do in the headache-free period and than do chronic migraine patients. In fact, the scale results suggest that cluster patients do not tend to monitor and control the physical or verbal expressions of anger to prevent explosive manifestations of their anger. A drawback of this report is the lack of a control group with no headaches. The investigators concluded that there are likely different bio-behavioral responses to stress in migraine and cluster headache patients. Stewart J. Tepper, MD, FAHS, Professor of Neurology, Geisel School of Medicine at Dartmouth, Director, Dartmouth Headache Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH