Reply to the Letter to the Editor: “Smell of migraine: Osmophobia as a clinical diagnostic marker”

Silva‐Néto, Raimundo Pereira; Rodrigues, Ânderson Batista; Cavalcante, Dandara Coelho; Ferreira, Pedro; Nasi, Ema Pereira; Sousa, Kamila Maria de Holanda; Soares, A.; Peres, Mario F P; Valênça, Marcelo Moraes

doi:10.1177/0333102416658716

Cited by 4 publications

(19 citation statements)

References 3 publications

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“…We field tested the ICHD-2 appendix criteria (1), the proposed criteria for MO that include osmophobia by Silva-Néto et al. (24) and by Wang et al. (32).…”

Section: Resultsmentioning

confidence: 99%

“…We tested the diagnostic criteria for MO suggested in the appendix of ICHD-2 (1) and by Silva-Néto et al. (24) and Wang et al. (25) .…”

Section: Methodsmentioning

confidence: 99%

“…The suggested revision of the ICHD-2 criterion D by Silva-Néto et al. was as follows: “During headache at least one of the following: (a) nausea and/or vomiting; (b) photophobia and phonophobia; and (c) osmophobia” (24). The suggested revision of the ICHD-2 criterion D by Wang et al.…”

Section: Methodsmentioning

confidence: 99%

“…Some studies have suggested including osmophobia in the headache classification (13,18,22,23) and Silva-Néto et al. (24), Wang et al. (25), and Ghandehari et al.…”

Section: Introductionmentioning

confidence: 99%

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Nosographic analysis of osmophobia and field testing of diagnostic criteria including osmophobia

2018

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Introduction Osmophobia has been suggested as an additional symptom of migraine without aura, and a high prevalence of osmophobia of up to 50% has been reported in the literature. We conducted a nosographic study of osmophobia in all migraineurs and tension-type headache patients and a field testing of suggested diagnostic criteria of osmophobia, presented in the appendix of the second edition of The International Classification of Headache Disorders and suggested by Silva-Néto et al. and Wang et al ., in migraine without aura and tension-type headache patients (n = 1934). Materials and methods Each patient received a validated semi-structured interview. All subjects fulfilled the diagnostic criteria of the second edition of The International Classification of Headache Disorders for migraine or tension-type headache. Statistical analyses were performed using statistical software R. The statistical R package "Caret" was used to construct a confusion matrix and retrieve sensitivity, which is defined as the suggested criteria's ability to correctly diagnose migraine without aura patients, and specificity, defined as the suggested criteria's ability to not wrongly diagnose tension-type headache patients. Results Osmophobia was present in 33.5% of patients with migraine with aura, in 36.0% of patients with migraine without aura, and in 1.2% of patients with tension-type headache. All migraineurs with osmophobia also fulfilled the current criteria for migraine by having nausea or photophobia and phonophobia. The appendix criteria had a sensitivity of 0.96 and a specificity of 0.99 for migraine without aura, and a sensitivity of 0.65 and a specificity of 0.99 for probable migraine without aura. Both the criteria by Silva-Néto et al. and Wang et al. had a sensitivity of 0.98 and a specificity of 0.99 for migraine without aura, and a sensitivity of 0.66 and a specificity of 0.99 for probable migraine without aura. Discussion This study demonstrates the remarkable specificity of osmophobia. The criteria by Silva-Néto et al. and Wang et al. both had a higher sensitivity than the appendix criteria for migraine without aura; all three criteria had a low sensitivity for probable migraine without aura. However, neither the appendix criteria nor the criteria by Silva-Néto et al. or Wang et al. added any extra patients that would not have been diagnosed by the current diagnostic criteria for migraine. Osmophobia is a valuable symptom that may be useful to differentiate between migraine without aura and tension-type headache in difficult clinical cases. Conclusion Our results do not suggest that alterations of the current diagnostic criteria for migraine without aura are needed.

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“…We field tested the ICHD-2 appendix criteria (1), the proposed criteria for MO that include osmophobia by Silva-Néto et al. (24) and by Wang et al. (32).…”

Section: Resultsmentioning

confidence: 99%

“…We tested the diagnostic criteria for MO suggested in the appendix of ICHD-2 (1) and by Silva-Néto et al. (24) and Wang et al. (25) .…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…Some studies have suggested including osmophobia in the headache classification (13,18,22,23) and Silva-Néto et al. (24), Wang et al. (25), and Ghandehari et al.…”

Section: Introductionmentioning

confidence: 99%

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Nosographic analysis of osmophobia and field testing of diagnostic criteria including osmophobia

2018

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“…In order to reach the maximum diagnostic accuracy, we believe that the proposal of a revised criterion D by Silva-Neto et al. (41) would be appropriate. Criterion D revisions according to the ICHD-2 Appendix version or Wang's proposal would include attacks with Os and photophobia, or with Os and phonophobia (4.3% of our cases, 22/512); both would not include attacks with Os alone (4.7% of cases in our study, 24/512).…”

Section: Discussionmentioning

confidence: 99%

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

Terrin

Mainardi

Lisotto³

et al. 2019

Cephalalgia

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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.

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Osmophobia in primary headache patients: associated symptoms and response to preventive treatments

et al. 2021

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Background Osmophobia, is common among primary headaches, with prevalence of migraine. The study aimed to evaluate prevalence and clinical characteristics of patients with osmophobia in a cohort of primary headache patients selected at a tertiary headache center. The second aim was to verify the possible predicting role of osmophobia in preventive treatment response in a sub cohort of migraine patients. Methods This was an observational retrospective cohort study based on data collected in a tertiary headache center. We selected patients aged 18–65 years, diagnosed as migraine without aura (MO), migraine with aura (MA) or Chronic Migraine (CM), Tension-Type Headache (TTH); and Cluster Headache (CH). We also selected a sub-cohort of migraine patients who were prescribed preventive treatment, according to Italian Guidelines, visited after 3 months follow up. Patients were considered osmophobic, if reported this symptom in at least the 20% of headache episodes. Other considered variables were: headache frequeny, the migraine disability assessment (MIDAS), Allodynia Symptom Checklist, Self-rating Depression scale, Self-rating Anxiety scale, Pain intensity evaluated by Numerical Rating Scale-NRS- form 0 to 10. Results The 37,9% of patients reported osmophobia (444 patients with osmophobia, 726 without osmophobia). Osmophobia prevailed in patients with the different migraine subtypes, and was absent in patients with episodic tension type headache and cluster headache (chi square 68.7 DF 7 p < 0.0001). Headache patients with osmophobia, presented with longer hedache duration (F 4.91 p 0.027; more severe anxiety (F 7.56 0.007), depression (F 5.3 p 0.019), allodynia (F 6 p 0.014), headache intensity (F 8.67 p 0.003). Tension type headache patients with osmophobia (n° 21), presented with more frequent headache and anxiety. A total of 711 migraine patients was visited after 3 months treatment. The change of main migraine features was similar between patients with and without osmophobia. Conclusions While the present study confirmed prevalence of osmophobia in migraine patients, it also indicated its presence among chronic tension type headache cases, marking those with chronic headache and anxiety. Osmophobia was associated to symptoms of central sensitization, as allodynia. It was not relevant to predict migraine evolution after first line preventive approach.

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Reply to the Letter to the Editor: “Smell of migraine: Osmophobia as a clinical diagnostic marker”

Cited by 4 publications

References 3 publications

Nosographic analysis of osmophobia and field testing of diagnostic criteria including osmophobia

Nosographic analysis of osmophobia and field testing of diagnostic criteria including osmophobia

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

Osmophobia in primary headache patients: associated symptoms and response to preventive treatments

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