A prospective study on osmophobia in migraine versus tension-type headache in a large series of attacks

Abstract

Background In literature, osmophobia is reported as a specific migrainous symptom with a prevalence of up to 95%. Despite the International Classification of Headache Disorders 2nd edition proposal of including osmophobia among accompanying symptoms, it was no longer mentioned in the ICHD 3rd edition. Methods We conducted a prospective study on 193 patients suffering from migraine without aura, migraine with aura, episodic tension-type headache or a combination of these. After a retrospective interview, each patient was asked to describe in detail osmophobia, when present, in the following four headache attacks. Results In all, 45.7% of migraine without aura attacks were associated with osmophobia, 67.2% of migraineurs reported osmophobia in at least a quarter of the attacks. No episodic tension-type headache attack was associated with osmophobia. It was associated with photophobia or phonophobia in 4.3% of migraine without aura attacks, and it was the only accompanying symptom in 4.7% of migraine without aura attacks. The inclusion of osmophobia in the ICHD-3 diagnostic criteria would enable a 9.0% increased diagnostic sensitivity. Conclusion Osmophobia is a specific clinical marker of migraine, easy to ascertain and able to disentangle the sometimes challenging differential diagnosis between migraine without aura and episodic tension-type headache. We recommend its inclusion among the diagnostic criteria for migraine as it increases sensitivity, showing absolute specificity.

Early use of acute medication for preventing migraine attacks: Results from a diary-based cohort study

“…This finding can be explained by the fact that moderate or severe headache was frequently associated with the use of acute medication (see Table 4). (14) 224 83a The proportion of days and the proportion of patients for whom a specific symptom was present on at least one day is listed.…”

“…12,13 We chose sensitivity to lights, noises, or odors because such sensitivity is specifically related to migraine attacks. [14][15][16] The aim of this study was to assess the prevalence of neck discomfort and sensitivity to sensory stimuli as well as the use of acute medication on migraine-free days in patients with episodic migraine, to analyze the impact of these symptoms on the risk of a forthcoming migraine attack, and to investigate whether neck discomfort and sensitivity to lights, noises, or odors could be indicators for taking acute medication early during the premonitory phase of a migraine attack.…”

“…12,13 We chose sensitivity to lights, noises, or odors because such sensitivity is specifically related to migraine attacks. 14 –16…”

Migraine Improvement During COVID‐19 Pandemic – A Case Report on the Wonders of a Mask

“…2 Several authors have pointed out osmophobia not only as very specific, but also a very insensitive element within the diagnosis of migraine, being rarely associated with another type of primary headache. 2,3 Recently, a prospective study found that 28% of persons with migraine disease reported osmophobia exclusively during a headache attack without any associated symptoms, including nausea/vomiting or photo/phonophobia, suggesting that the inclusion of osmophobia in the International Classification of Headache Disorders-3 criteria for migraine would allow an increased diagnostic sensitivity by 9%; 3 however, this inclusion proposal remains a subject of debate. 2 Few studies have shown that odors may also trigger headache attacks, even in low concentrations and with odors that are commonly well tolerated by the general population.…”

“…2 Few studies have shown that odors may also trigger headache attacks, even in low concentrations and with odors that are commonly well tolerated by the general population. 2,3 Perfume fragrances are the most often reported triggers, particularly those with floral scent; 2 others include cigarette smoke, cleaning products, petroleum-derived products, or certain foods, in particular those with strong flavors and rarely alliaceous foods (like onions). 4 The mean time interval for triggering headache has been recorded as anything from few minutes to 118 minutes.…”