Migraine is associated with bidirectional increased risk of anxiety and depression. These comorbidities do not establish that any one condition causes another, but their association implies underlying epidemiological, and probable pathophysiologic shared mechanisms. Exploring this further, the authors note that “cognitive vulnerabilities, like anxiety sensitivity, play a key role in the comorbidity between emotional disorders and physical illness.” They note that anxiety sensitivity is associated in a key negative way with both the emotional distress of migraine and related migraine symptoms, and they list “irritability, difficulty concentrating, anxiety, depressed mood, anxiety, fatigue, and sleep disturbance,” as well as migraine attack duration and migraine severity. The investigators also found a relationship between anxiety sensitivity and menstrual-related migraine attacks and speculate on female hormonal changes that might account for these relationships. Most importantly, they note that “this is the first study to consider anxiety sensitivity as a female-specific vulnerability related to migraine.” —Stewart J. Tepper, MD, FAHS, Professor of Neurology, Geisel School of Medicine at Dartmouth, Director, Dartmouth Headache Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH