Osmophobia and Odor‐Triggered Headaches in Children and Adolescents: Prevalence, Associated Factors, and Importance in the Diagnosis of Migraine

Abstract

Objective.-The objectives of this study are to study osmophobia and odor-triggered headaches among headache pediatric patients.Background.-Achieving the correct diagnosis for headaches in younger children can be challenging. The presence of osmophobia could constitute a helpful piece of information for making the correct diagnosis of headaches among adults.Methods.-This was a cross-sectional study. Children and adolescents with headaches who were seen consecutively at a pediatric outpatient service and had at least 1 headache attack over the previous 12 months were included. We used a semi-structured questionnaire, Pediatric Migraine Disability Assessment, State-Trait Anxiety Inventory, and Children's Depression Inventory.Results.-About 300 patients were included; 253 had migraine, 47 had a tension-type headache; 137 had osmophobia during headaches (135 were migraineurs). "Osmophobia during headaches" for diagnosing migraine: Sensitivity: 54.4% (95% CI: 48.2%-60.5%); specificity: 95.8% (95% CI: 85.8%-98.8%); positive predictive value (PPV): 98.5% (95% CI: 94.8%-99.6%); negative predictive value (NPV): 28.5% (95% CI: 22.0%-36.0%). Osmophobia was associated with higher intensity (OR: 2.90; 95% CI: 1.63, 5.15; P < .001) and duration of the headache (OR: 5.73; 95% CI: 2.29, 14.3; P < .001) and with vomiting (OR: 3.56; 95% CI: 1.83, 6.96; P < .001) (logistic regression). There were 62 patients (all of them migraineurs) with odor-triggered headaches: sensitivity for diagnosing migraine: 24.9% (95% CI: 19.9%-30.6%); specificity: 100% (95% CI: 92.4%-100%), PPV: 100% (95% CI: 94.8%-100%), NPV: 20% (95% CI: 16%-26.0%). Odor-triggered headaches were associated with higher intensity (OR: 3.47; 95% CI: 1.64, 7.35; P = .001) and duration of the headache (OR: 3.28; 95% CI: 1.37, 7.86; P = .001), vomiting (OR: 2.37; 95% CI: 1.19, 4.74; P = .014), and phonophobia (OR: 2.40; 95% CI: 1.08, 5.32; P = .031) (logistic regression). Osmophobia was associated with higher-impact migraine (OR: 4.65; 95% CI: 1.30, 16.6; P = .018) and emergency care (OR: 4.65; 95% CI: 1.81, 12.0; P = .001) (logistic regression).Conclusions.-Osmophobia and odors as triggers for headaches are useful in diagnosing migraine and are markers for the severity of migraine in the pediatric population. Abbreviations: NPV negative predictive value, PedMIDAS-BP Brazilian version of the Pediatric Migraine DisabilityAssessment, PPV positive predictive value (Headache 2020;60:954-966) Headache

Epidemiology of Headache in Children and Adolescents—Another Type of Pandemia

“…Migraine appears as uni- or bilateral, sharp, pulsating or dull, oppressive pain, up to high intensity, ranging over a time period of 60 min to 72 h (including sleep), mostly with photo/phonophobia, osmophobia, and vegetative syndromes such as nausea and vomiting, improvement by retreating in a dark room and sleep, worsening by physical activity, without any explainable other reason [ 42 ]. TTH and migraine are mostly episodic (less than 15 headache days a month), rarely chronic with more than 15 headache days and in chronic migraine at least 8 migraine days per month.…”

Effectiveness of three calcitonin gene-related peptide monoclonal antibodies for migraine: A 12-month, single-center, observational real-world study in Japan

“…However, other sensory hypersensitivity symptoms or accompanying symptoms were not significant predictors for ≥50% responders. Although the diagnostic criteria for migraine in the latest ICHD-3 do not include osmophobia among migraine-specific features, its presence may be useful in the diagnosis of migraine and predicting headache severity (23). As in previous studies, a relatively high rate of osmophobia (68.3%), possibly related to interracial differences between Asian and Western populations (24), was observed in this study.…”

Pathophysiology and Therapy of Associated Features of Migraine

“…Nevertheless, the presence of osmophobia may be related to more florid migraine phenotypes and greater disability, and a scale has been developed recently for the quantification of quality of life related to osmophobia [ 117 ]. Migraineurs that present with ictal osmophobia may have more painful headaches [ 118 , 119 ]. Ictal and interictal osmophobia have been associated with a longer history of migraines or high frequency of the attacks, as well as other associated symptoms, such as cranial allodynia [ 120 , 121 , 122 ], suggesting a central sensitization process [ 123 ].…”

“…Ictal and interictal osmophobia have been associated with a longer history of migraines or high frequency of the attacks, as well as other associated symptoms, such as cranial allodynia [ 120 , 121 , 122 ], suggesting a central sensitization process [ 123 ]. Vomiting can also be more common in the presence of osmophobia [ 119 , 121 ]. Osmophobic migraineurs may also have a higher prevalence of psychiatric comorbidities than those without it [ 118 , 124 , 125 , 126 ].…”

“…Osmophobia has been proposed as a specific marker, helpful for the diagnosis of migraine [ 119 , 124 , 127 , 128 , 129 , 130 , 131 , 132 ]; however, it is not very sensitive [ 122 ]. Around half of the patients with migraines reported an increased sense of smell or reduced tolerability to smells [ 129 , 133 ].…”