A prospective study on osmophobia in migraine versus tension-type headache in a large series of attacks. (April 2020)

• Record Type: Journal Article
• Authors: Terrin, Alberto; Mainardi, Federico; Lisotto, Carlo; Mampreso, Edoardo; Fuccaro, Matteo; Maggioni, Ferdinando; Zanchin, Giorgio
• Is Part Of: Cephalalgia. Volume 40:Number 4(2020)
• Page Start: 337
• Page End: 346
• Publication Date: 2020-04
• Subjects: Primary headaches -- smell -- trigger -- diagnostic criteria; Headache -- Periodicals; 616.8491
• DOI: 10.1177/0333102419877661
• Languages: English
• ISSNs: 0333-1024

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.