{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T05:23:18Z","timestamp":1791091398934,"version":"4.1.0"},"reference-count":170,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2012,12,26]],"date-time":"2012-12-26T00:00:00Z","timestamp":1356480000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Headache"],"published-print":{"date-parts":[[2013,1]]},"abstract":"<jats:p>\n                    A growing body of literature suggests that comorbid anxiety disorders are more common and more prognostically relevant among migraine sufferers than comorbid depression. Panic disorder (\n                    <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>\n                    ) appears to be more strongly associated with migraine than most other anxiety disorders.\n                    <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>\n                    and migraine are both chronic diseases with episodic manifestations, involving significant functional impairment and shared symptoms during attacks, interictal anxiety concerning future attacks, and an absence of identifiable secondary pathology. A meta\u2010analysis of high\u2010quality epidemiologic study data from 1990 to 2012 indicates that the odds of\n                    <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>\n                    are 3.76 times greater among individuals with migraine than those without. This association remains significant even after controlling for demographic variables and comorbid depression. Other less\u2010rigorous community and clinical studies confirm these findings. The highest rates of\n                    <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>\n                    are found among migraine with aura patients and those presenting to specialty clinics. Presence of\n                    <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>\n                    is associated with greater negative impact of migraine, including more frequent attacks, increased disability, and risk for chronification and medication overuse. The mechanisms underlying this common comorbidity are poorly understood, but both pathophysiological (eg, serotonergic dysfunction, hormonal influences, dysregulation of the hypothalamic\u2013pituitary\u2013adrenal axis) and psychological (eg, interoceptive conditioning, fear of pain, anxiety sensitivity, avoidance behavior) factors are implicated. Means of assessing comorbid\n                    <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>\n                    among treatment\u2010seeking migraineurs are reviewed, including verbal screening for core\n                    <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>\n                    symptoms, ruling out medical conditions with panic\u2010like features, and administering validated self\u2010report measures. Finally, evidence\u2010based strategies for both pharmacologic and behavioral management are outlined. The first\u2010line migraine prophylactics are not indicated for\n                    <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>\n                    , and the selective serotonin re\u2010uptake inhibitors used to treat\n                    <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>\n                    are not efficacious for migraine; thus, separate agents are often required to address each condition. Core components of behavioral treatments for\n                    <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>\n                    are reviewed, and their integration into clinical headache practice is discussed.\n                  <\/jats:p>","DOI":"10.1111\/head.12004","type":"journal-article","created":{"date-parts":[[2012,12,26]],"date-time":"2012-12-26T09:07:50Z","timestamp":1356512870000},"page":"23-45","source":"Crossref","is-referenced-by-count":90,"title":["Panic Disorder and Migraine: Comorbidity, Mechanisms, and Clinical Implications"],"prefix":"10.1111","volume":"53","author":[{"given":"Todd A.","family":"Smitherman","sequence":"first","affiliation":[{"name":"Department of Psychology University of Mississippi  Oxford MS USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth D.","family":"Kolivas","sequence":"additional","affiliation":[{"name":"Department of Psychology University of Mississippi  Oxford MS 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