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