Exploring the contributing factors to multiple chemical sensitivity in patients with migraine

Abstract

Objective Multiple chemical sensitivity (MCS) is a form of chemical intolerance in which various systemic symptoms are triggered by exposure to a variety of chemical substances. Although migraine has been associated with central sensitivity syndrome, the relationship between MCS and migraine has not been studied. We assessed the frequency of MCS and its related factors in patients with migraine. Methods We performed a cross‐sectional study that included 95 patients (14 M/81 F; age, 45.4 ± 12.4 years) out of 100 consecutive patients with migraine from our outpatient headache clinic. MCS was defined as having a combination of Q1 ≥ 30, Q3 ≥ 13, and Q5 ≥ 17 on the quick environment exposure sensitivity inventory (QEESI; Japanese version). Central sensitization inventory‐A scores >40 were considered an indication of central sensitization. Headache‐related disability and psychological distress were evaluated with the Migraine Disability Assessment score (MIDAS) and Kessler Psychological Distress Scale (K6), respectively. Results MCS was identified in 20% of patients with migraine; however, none had previously been diagnosed with MCS. The MCS‐positive group had higher rates of photophobia, osmophobia, visual aura, sensory aura, and central sensitization and higher MIDAS and K6 scores than the MCS‐negative group. A logistic regression analysis showed that osmophobia, sensory aura, and central sensitization were significant contributors to MCS. Conclusion We showed that MCS was observed in 20% of patients with migraine, and our study results may indicate a possible association of MCS with central sensitization and hypersensitivity‐related symptoms in patients with migraine.

Central Sensitization in Migraine: A Narrative Review

“…Migraine patients with MCS had higher rates of photophobia, osmophobia, visual aura, sensory aura, and CS as well as higher migraine-related disability and Kessler Psychological Distress scores than those without MCS. 56 This study showed a possible association of MCS with CS and hypersensitivity-related symptoms, such as photophobia and osmophobia, in migraine patients.…”

“…The determinants of CS in migraine patients were restless legs syndrome and interference of headache pain with daily activities. Danno et al, 54 (2022) 164 patients with migraine A cross-sectional study using CSI CS was observed in 32.3% of migraine patients and was related to cranial parasympathetic symptoms such as lacrimation, aural fullness, nasal blockage, and rhinorrhea, Suzuki et al, 56 (2022) 95 patients with migraine A cross-sectional study using CSI and QEESI Multiple chemical sensitivity was found in 20% of migraine patients and was related to CS, photophobia, osmophobia, visual aura, sensory aura, higher migraine-related disability and Kessler Psychological Distress scores. Note : CSI scores ≥ 40 were defined as having CS.…”

Pathophysiology and Therapy of Associated Features of Migraine

“…Activation of the amygdala and orbitofrontal cortex might be related, respectively, with the intensity and valence of the smell emotional experience [ 143 ]. The amygdala and cingulate cortex also showed abnormal activation in patients with multiple chemical sensitivity [ 144 , 145 ], which is associated with a high prevalence of headache [ 146 ] and was observed in up to 20% of migraineurs [ 147 ].…”

Low- to moderate-level chemical exposures can trigger migraines and are associated with multiple chemical sensitivity

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I appreciate the excellent paper on multiple chemical sensitivity (MCS) in migraine patients by Suzuki et al 1 This study reported that 19 (20%) of a group of 95 adolescents and adults with chronic migraine met Quick Environmental Exposure Sensitivity Index (QEESI) criteria for MCS. 1 Among the 19 migraine patients with MCS, the levels of sensory aura, central sensitization, and osmophobia (sensitivity to odors).were significantly higher than for the 76 migraine patients without MCS.

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“…1 Among the 19 migraine patients with MCS, the levels of sensory aura, central sensitization, and osmophobia (sensitivity to odors).were significantly higher than for the 76 migraine patients without MCS. 1 A number of studies have reported that exposure to lower to moderate levels of many chemicals, including exposure to pesticides, organic solvents, and outdoor levels of many pollutants including PM 2.5 , CO, NO 2 , and SO 2 , are associated with increased risk of migraines and other headaches. [2][3][4] In 1992, Martin and Becker reported on a group of 50 patients who experienced severe headaches from lowlevel exposure (43 patients) to high-level exposure (7 patients).…”