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Pieniak M, Höfer B, Knipping J, Faria V, Richter M, Schriever VA, Haehner A, Gossrau G. Children and adolescents with primary headaches exhibit altered sensory profiles - a multi-modal investigation. J Headache Pain 2024; 25:111. [PMID: 38982389 PMCID: PMC11234718 DOI: 10.1186/s10194-024-01819-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/27/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Pediatric headache is an increasing medical problem that has adverse effects on children's quality of life, academic performance, and social functioning. Children with primary headaches exhibit enhanced sensory sensitivity compared to their healthy peers. However, comprehensive investigations including multimodal sensory sensitivity assessment are lacking. This study aimed to compare sensory sensitivity of children with primary headaches with their healthy peers across multiple sensory domains. METHODS The study included 172 participants aged 6 to 17 years (M = 13.09, SD = 3.02 years; 120 girls). Of these 80 participants were patients with migraine, 23 were patients with tension-type headache, and 69 were healthy controls. The following sensory measures were obtained: Mechanical Detection Threshold (MDT), Mechanical Pain Threshold (MPT), Mechanical Pain Sensitivity (MPS), detection and pain threshold for Transcutaneous Electrical Nerve Stimulation (TENS), olfactory and intranasal trigeminal detection threshold, and odor identification ability. Sensory sensitivity was compared between groups with a series of Kruskal-Wallis tests. Binomial regression models were used to compare the relative utility of sensory sensitivity measures in classifying participants into patients and healthy controls, as well as into patients with migraine and tension-type headache. RESULTS Patients with migraine had lower MPT measured at the forearm than patients with tension-type headaches and healthy controls. MPS was higher in patients with migraine than in healthy controls. All patients with headaches had lower detection threshold of TENS and higher olfactory sensitivity. Healthy controls showed increased intranasal trigeminal sensitivity. Scores in MPS, TENS, and olfactory and trigeminal thresholds were significantly predicting presence of primary headaches. Additionally, scores in MPT, olfactory and trigeminal threshold were positive predictors of type of headache. CONCLUSIONS Children with primary headaches exhibit different sensory profiles than healthy controls. The obtained results suggest presence of increased overall, multimodal sensitivity in children with primary headaches, what may negatively impact daily functioning and contribute to further pain chronification. TRIAL REGISTRATION The study was registered in the German Registry of Clinical Trials (DRKS) DRKS00021062.
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Affiliation(s)
- Michal Pieniak
- Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Smell & Taste Clinic, University Hospital, TU Dresden, Dresden, Germany
- Institute of Psychology, University of Wroclaw, Wroclaw, Poland
| | - Berit Höfer
- Interdisciplinary Pain Center, Faculty of Medicine Carl Gustav Carus, University Hospital, TU Dresden, Dresden, Germany
| | - Jenny Knipping
- Department of Pediatric Neurology, Faculty of Medicine Carl Gustav Carus, University Hospital, TU Dresden, Dresden, Germany
| | - Vanda Faria
- Interdisciplinary Pain Center, Faculty of Medicine Carl Gustav Carus, University Hospital, TU Dresden, Dresden, Germany
| | - Matthias Richter
- Department of Pediatrics, Faculty of Medicine Carl Gustav Carus, University Hospital, Dresden, TU, Germany
| | - Valentin A Schriever
- Department of Pediatric Neurology, Faculty of Medicine Carl Gustav Carus, University Hospital, TU Dresden, Dresden, Germany
- Department of Pediatrics, Pediatric Neurology, Neurometabolics and Prevention, Goethe University Frankfurt, Frankfurt, Germany
| | - Antje Haehner
- Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Smell & Taste Clinic, University Hospital, TU Dresden, Dresden, Germany
| | - Gudrun Gossrau
- Interdisciplinary Pain Center, Faculty of Medicine Carl Gustav Carus, University Hospital, TU Dresden, Dresden, Germany.
- Interdisciplinary Pain Center, Faculty of Medicine Carl Gustav Carus, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
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Li Y, Yolland COB, Rossell SL, Sommer IEC, Toh WL. Multisensory hallucinations and other unusual sensory experiences in the context of migraine: a systematic review. J Neurol 2024; 271:1717-1746. [PMID: 38236395 PMCID: PMC10972994 DOI: 10.1007/s00415-023-12144-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE AND BACKGROUND Visual auras in migraine have been extensively studied, but less is known about multisensory hallucinations or other unusual sensory experiences, including whether these should be diagnostically considered as part of aura symptoms. The current study aimed to conduct a systematic review and synthesis to bring together existing empirical evidence on these non-visual perceptual experiences, focusing on their phenomenological descriptions and clinical correlates. METHODS Forty-eight relevant studies were included based on a systematic search across PsycINFO APA and Web of Science, for peer-reviewed publications in the English language, from 1980 to the present. These comprised a mix of case reports/series (n = 19) and group design studies (n = 29). RESULTS Reports of complex multisensory hallucinations, beyond typical established aura symptoms, were numerous and varied in nature. Yet there were limited data on how this related to patient distress and functional interference. Other sensory distortions or hypersensitivities across non-visual domains were also evident, and generally more common in those with established aura symptoms. CONCLUSION Our findings provide preliminary evidence that multisensory hallucinations and other unusual perceptual experiences in migraine are likely more common than previously believed. Further investigations are needed to appropriately account for these symptoms within current nosological systems. Increased clinician-patient awareness is important for managing distress (where necessary), and potentially for offering a holistic therapeutic approach to migraine management.
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Affiliation(s)
- Yixuan Li
- Centre for Mental Health & Brain Sciences, Swinburne University of Technology, P.O. Box 218, Hawthorn, VIC, 3122, Australia
| | - Caitlin O B Yolland
- Centre for Mental Health & Brain Sciences, Swinburne University of Technology, P.O. Box 218, Hawthorn, VIC, 3122, Australia.
- Academic Services, Boundless Learning, Melbourne, VIC, Australia.
| | - Susan L Rossell
- Centre for Mental Health & Brain Sciences, Swinburne University of Technology, P.O. Box 218, Hawthorn, VIC, 3122, Australia
- Department of Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Iris E C Sommer
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, The Netherlands
- Graduate School of Medical Sciences (Research School of Behavioural and Cognitive Neurosciences), University of Groningen, Groningen, The Netherlands
| | - Wei Lin Toh
- Centre for Mental Health & Brain Sciences, Swinburne University of Technology, P.O. Box 218, Hawthorn, VIC, 3122, Australia
- Department of Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia
- Department of Psychology, Alfred Hospital, Melbourne, VIC, Australia
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Ikumi N, Marti-Marca A, Torre-Suñe ADL, Cerda-Company X, Vilà-Balló A, Gallardo VJ, Caronna E, Alpuente A, Pozo-Rosich P. Quantifying sensory thresholds along the migraine cycle: An exploratory longitudinal study. Cephalalgia 2024; 44:3331024241230279. [PMID: 38416486 DOI: 10.1177/03331024241230279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND To date, a number of studies on migraine have cross-sectionally evaluated sensory sensitivity with aversion thresholds/scores along the migraine cycle, reporting a decreased tolerance to sensory stimuli in different sensory modalities. Our hypothesis was that patients with migraine would exhibit heightened sensitivity to sound, light, touch and smell on days where they reported greater headache intensity. METHODS This is an exploratory, longitudinal study, carried out over the course of 27 days. Aversion thresholds or scores to sound, light, touch and smell were quantified in six patients with migraine (11.33 ± 6.53 headache days/month). RESULTS Patients reported an increased sensitivity to light (padj = 0.0297), touch (padj = 0.0077), and smell (padj = 0.0201) on days with higher headache intensity. However, a greater sensitivity to sound on days with higher headache intensity was only reported when anxiety levels were high (padj = 1.4e-06). Interestingly, variable levels of tolerance to bothersome light over time can also influence the correlation between light sensitivity and headache intensity (padj = 1.4e-06). CONCLUSIONS Based on the present findings, future longitudinal studies evaluating sensory threshold changes along the migraine cycle in patients with migraine should account for the increased tolerance to bothersome light over time as well as the effect of anxiety on auditory sensitivity.
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Affiliation(s)
- Nara Ikumi
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Angela Marti-Marca
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna de la Torre-Suñe
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xim Cerda-Company
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Adrià Vilà-Balló
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Victor J Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edoardo Caronna
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alicia Alpuente
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Straburzynski M, Nowaczewska M, Czapinska-Ciepiela EK, Gryglas-Dworak A, Budrewicz S, Waliszewska-Prosół M. Sinonasal symptoms in migraine without aura: results from the cross-sectional 'Migraine in Poland' study. Front Neurol 2023; 14:1321261. [PMID: 38046593 PMCID: PMC10690933 DOI: 10.3389/fneur.2023.1321261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023] Open
Abstract
Background Migraine without aura (MwoA) is often mistaken for rhinosinusitis. The purpose of this study was to assess the prevalence of sinonasal symptoms, sinusitis-targeting medication use and burden of migraine in a large group of people with MwoA attacks accompanied by rhinologic symptoms. Methods Data was collected in a cross-sectional online survey based on an adapted population-based study questionnaire. The analysis included the prevalence of rhinorrhea, mucopurulent nasal discharge, nasal congestion, facial pressure and tenderness to palpation, hyposmia/anosmia and osmophobia. Results 1,679 (52.73%) MwoA people were identified among 3,225 respondents (women n = 2,809, 87.10%) aged 13-80 years (median age 39; standard deviation 10.4). 1004/1679 (59.8%) migraine patients reported one or more rhinologic symptoms and 341/1679 (20.3%) MwoA respondents had symptoms that met rhinosinusitis clinical diagnostic criteria during their headache attacks. In migraine patients, osmophobia was associated with hyposmia [n = 141 (12.7%) vs. n = 41 (7.2%); p = 0.001] and a sensation of unpleasant smells [n = 216 (19.4%) vs. n = 45 (8.5%); p = 0.001], while facial tenderness to palpation was associated with facial allodynia [n = 532 (50.4%) vs. n = 211 (33.9%); p < 0.001]. People with migraine accompanied by rhinosinusitis-like symptoms experienced more disease burden and used 'sinus medications' more often. Conclusion MwoA patients with rhinosinusitis-like symptoms during migraine attacks require cautious assessment, especially that some symptoms seem to have little value in distinguishing between these disorders (i.e., facial tenderness, hyposmia), while many of these patients have a greater disease burden and therefore often choose medications targeting rhinologic instead of neurologic mechanisms.
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Affiliation(s)
- Marcin Straburzynski
- Department of Family Medicine and Infectious Diseases, University of Warmia and Mazury, Olsztyn, Poland
| | - Magdalena Nowaczewska
- Department of Otolaryngology, Head and Neck Surgery and Laryngological Oncology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
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Faria V, Dulheuer J, Joshi A, Wahl H, Klimova A, Haehner A, Gossrau G. Impact of a 12-week olfactory training programme in women with migraine with aura: protocol for a double-blind, randomised, placebo-controlled trial. BMJ Open 2023; 13:e071443. [PMID: 37419649 PMCID: PMC10335595 DOI: 10.1136/bmjopen-2022-071443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 06/04/2023] [Indexed: 07/09/2023] Open
Abstract
INTRODUCTION Migraine is a leading cause of disability and suffering worldwide. However, conventional pharmacological migraine preventive therapies are often challenging and accompanied by adverse effects. Recently, structured odour exposure has shown to successfully increase pain thresholds in patients with chronic back pain. Despite the importance of the olfactory system in migraine, there are no studies investigating the impact of structured odour exposure in patients with migraine. METHODS AND ANALYSIS This double-blind randomised placebo-controlled trial will be conducted at the Headache Clinic of the University Pain Center at TU Dresden, Germany and aims at investigating the impact of a 12-week structured exposure to odours in women with migraine. Fifty-four women between 18 and 55 years with migraine with aura will be recruited and randomised to training with odours and odourless training. The primary outcomes are mechanical and electrical pain thresholds. Secondary outcomes comprise olfactory threshold and the number of headache days. Other exploratory measurements are headache associated pain intensity, acute analgesic intake, symptoms of anxiety and depression, and quality of life. Additionally, this protocol assesses neuroanatomical and neurofunctional changes associated with the 12-week olfactory training. Data analysis will be executed on the basis of the general linear model considering repeated measurements. ETHICS AND DISSEMINATION Ethical approvals were obtained from the Ethics Board of the TU Dresden (Protocol No. BO-EK-353082020). Participation will only be possible after written informed consent is provided. Findings will be disseminated through peer-reviewed journals and scientific conferences. TRIAL REGISTRATION NUMBER DRKS00027399.
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Affiliation(s)
- Vanda Faria
- Department of Otorhinolaryngology, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, Germany
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jana Dulheuer
- Department of Otorhinolaryngology, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Akshita Joshi
- Department of Otorhinolaryngology, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Hannes Wahl
- Intitute of Neuroradiology, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Anna Klimova
- NCT Partner Site Dresden, Institute for Medical Informatics and Biometrics, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Antje Haehner
- Department of Otorhinolaryngology, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Gudrun Gossrau
- Interdisciplinary Pain Center, University Hospital, and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
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Imai N, Osanai A, Moriya A, Katsuki M, Kitamura E. Classification of odors associated with migraine attacks: a cross-sectional study. Sci Rep 2023; 13:8469. [PMID: 37230996 DOI: 10.1038/s41598-023-35211-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
Migraine, a common primary headache disorder, is associated with various factors such as stress, hormones in women, fasting, weather, and sleep disturbance as well as odors. We aimed to categorize odors associated with migraine and explore their relationships with clinical characteristics. A total of 101 migraineurs answered a questionnaire to determine the odors associated with migraine attacks. We performed factor analysis to explore the common factors of the odors and the relationship between these factors and the clinical characteristics. The factor analysis estimated six common factors: factor 1, fetid odor; factor 2, cooking products; factor 3, oil derivatives and others; factor 4, shampoo and conditioner; factor 5, cleaning products; factor 6, perfumes, insecticides, and rose. Factor 5 also included hair styling preparations, laundry detergent, and fabric softener, usually those with floral fragrances, and factor 5 was more likely to be associated with migraine attacks in patients with chronic migraine than in those with episodic migraine (P = 0.037). Our study showed that odors associated with migraine attacks could be categorized into six groups and suggested that some chemicals were more likely associated with migraine attacks in patients with chronic migraine than in those with episodic migraine.
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Affiliation(s)
- Noboru Imai
- Department of Neurology, Japanese Red Cross Shizuoka Hospital, 8-2 Ohtemachi, Aoi-Ku, Shizuoka, Shizuoka, 420-0853, Japan.
| | - Ayako Osanai
- Department of Neurology, Japanese Red Cross Shizuoka Hospital, 8-2 Ohtemachi, Aoi-Ku, Shizuoka, Shizuoka, 420-0853, Japan
| | - Asami Moriya
- Department of Neurology, Japanese Red Cross Shizuoka Hospital, 8-2 Ohtemachi, Aoi-Ku, Shizuoka, Shizuoka, 420-0853, Japan
| | - Masahito Katsuki
- Department of Neurosurgery, Itoigawa General Hospital, Itoigawa, Niigata, Japan
| | - Eiji Kitamura
- Department of Neurology, Kitasato University, Sagamihara, Kanagawa, Japan
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Mignot C, Faria V, Hummel T, Frost M, Michel CM, Gossrau G, Haehner A. Migraine with aura: less control over pain and fragrances? J Headache Pain 2023; 24:55. [PMID: 37198532 DOI: 10.1186/s10194-023-01592-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/04/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Accumulating data emphasizes the importance of olfaction in migraine pathophysiology. However, there are only a few studies evaluating how the migraine brain processes olfactory stimulation, and virtually no studies comparing patients with and without aura in this context. METHODS This cross-sectional study recorded event-related potentials from 64 electrodes during a pure olfactory or pure trigeminal stimulus in females with episodic migraine with aura (n = 13) and without aura (n = 15), to characterize the central nervous processing of these intranasal stimuli. Patients were tested in interictal state only. Data were analyzed in the time domain and in the time-frequency domain. Source reconstruction analysis was also performed. RESULTS Patients with aura had higher event-related potentials amplitudes for left-sided trigeminal and left-sided olfactory stimulations, and higher neural activity for right-sided trigeminal stimulation in brain areas related to trigeminal and visual processing. Following olfactory stimulations patients with aura displayed decreased neural activity in secondary olfactory structures compared to patients without aura. Oscillations in the low frequency bands (< 8 Hz) differed between patient groups. CONCLUSIONS Altogether this may reflect hypersensitivity to nociceptive stimuli in patients with aura relative to patients without aura. Patients with aura have a bigger deficit in engaging secondary olfactory-related structures, possibly leading to distorted attention and judgements towards odors. The cerebral overlap between trigeminal nociception and olfaction might explain these deficits.
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Affiliation(s)
- Coralie Mignot
- Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Smell & Taste Clinic, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Vanda Faria
- Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Smell & Taste Clinic, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Department of Psychology, Uppsala University, 752 37, Uppsala, Sweden
- Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, MA 02115, USA
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, MA 02115, USA
| | - Thomas Hummel
- Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Smell & Taste Clinic, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Marie Frost
- Comprehensive Pain Center, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christoph M Michel
- Department of Basic Neurosciences, University of Geneva, CH-1211, Geneva 4, Switzerland
- CIBM Center for Biomedical Imaging, 1015, Lausanne, Switzerland
| | - Gudrun Gossrau
- Comprehensive Pain Center, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Antje Haehner
- Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Smell & Taste Clinic, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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Villar-Martinez MD, Goadsby PJ. Pathophysiology and Therapy of Associated Features of Migraine. Cells 2022; 11:cells11172767. [PMID: 36078174 PMCID: PMC9455236 DOI: 10.3390/cells11172767] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Migraine is a complex and debilitating disorder that is broadly recognised by its characteristic headache. However, given the wide array of clinical presentations in migraineurs, the headache might not represent the main troublesome symptom and it can even go unnoticed. Understanding migraines exclusively as a pain process is simplistic and certainly hinders management. We describe the mechanisms behind some of the most disabling associated symptoms of migraine, including the relationship between the central and peripheral processes that take part in nausea, osmophobia, phonophobia, vertigo and allodynia. The rationale for the efficacy of the current therapeutic arsenal is also depicted in this article. The associated symptoms to migraine, apart from the painful component, are frequent, under-recognised and can be more deleterious than the headache itself. The clinical anamnesis of a headache patient should enquire about the associated symptoms, and treatment should be considered and individualised. Acknowledging the associated symptoms as a fundamental part of migraine has permitted a deeper and more coherent comprehension of the pathophysiology of migraine.
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Affiliation(s)
- Maria Dolores Villar-Martinez
- Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London WC2R 2LS, UK
- NIHR King’s Clinical Research Facility, SLaM Biomedical Research Centre, King’s College Hospital, London SE5 9RS, UK
| | - Peter J. Goadsby
- Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London WC2R 2LS, UK
- NIHR King’s Clinical Research Facility, SLaM Biomedical Research Centre, King’s College Hospital, London SE5 9RS, UK
- Department of Neurology, University of California, Los Angeles, CA 90095, USA
- Correspondence:
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Gossrau G, Frost M, Klimova A, Koch T, Sabatowski R, Mignot C, Haehner A. Interictal osmophobia is associated with longer migraine disease duration. J Headache Pain 2022; 23:81. [PMID: 35840888 PMCID: PMC9284850 DOI: 10.1186/s10194-022-01451-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/01/2022] [Indexed: 11/20/2022] Open
Abstract
Background Sensitization to sensory stimuli is an essential feature of migraine attacks. The relationship between the clinical course of migraine and increased sensitivity to olfactory stimuli has been little studied so far. Methods We analyzed the frequency and quality of osmophobia depending on the phase of migraine in patients with episodic and chronic migraine treated in an tertiary headache center with regard to gender, age, medical history and migraine disability assessment score (MIDAS). Standardized diagnostic questions were used for the assessment of osmophobia. Results In our cross-sectional investigation (n = 113), 38.1% of the patients showed an increased preictal hypersensitivity to odors, whereas 61.9% described ictal and 31.9% interictal hypersensitivity to odors, odor-triggered migraine was described in 30.1%. Median migraine disease duration has been statistically significantly longer in patients who suffered from interictal hypersensitivity to odors (28.5 years vs. 20 years; p = 0.012). There was a significant correlation between interictal hypersensitivity and higher age (54.50 vs. 45; p = 0.015). Patients with higher migraine disability in MIDAS experienced more frequently preictal and interictal olfactory sensitization and odor triggered migraine attacks. Conclusions In patients with longer migraine disease duration and higher migraine-related impairment, osmophobia was more frequently observed. These results might support the hypothesis of increasing sensitization with increasing burden of migraine.
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Affiliation(s)
- Gudrun Gossrau
- University Pain Center Dresden, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Marie Frost
- University Pain Center Dresden, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Anna Klimova
- NCT Partner Site Dresden, Institute for Medical Informatics and Biometrics, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Thea Koch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Rainer Sabatowski
- University Pain Center Dresden, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.,Department of Anesthesiology and Intensive Care Medicine, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Coralie Mignot
- Department of Otorhinolaryngology, Smell & Taste Clinic, TU Dresden, Dresden, Germany
| | - Antje Haehner
- Department of Otorhinolaryngology, Smell & Taste Clinic, TU Dresden, Dresden, Germany
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Kandemir S, Pamuk AE, Habipoğlu Y, Özel G, Bayar Muluk N, Kılıç R. Olfactory acuity based on Brief Smell Identification Test (BSIT Ⓡ) in migraine patients with and without aura: A cross-sectional, controlled study. Auris Nasus Larynx 2021; 49:613-617. [PMID: 34930631 DOI: 10.1016/j.anl.2021.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate olfactory acuity in migraine patients with and without aura (MwA and MwoA) MATERIAL AND METHODS: The study included 30 MwA patients, 30 MwoA patients, and 30 age- and gender-matched controls. Demographic features and odor-related symptoms (osmophobia, odor offensiveness, and odor-triggered attack status) were noted. Olfactory acuity was measured using the Brief Smell Identification Test (BSIT®), a 12-item derivative of the University of Pennsylvania Smell Identification Test (UPSIT®). BSIT® scores were compared between the migraine patients and controls. RESULTS The mean BSIT® score did not differ significantly between the MwA patients (8.7 ± 0.9) and MwoA (9.17 ± 0.9) patients (P = 0.094); however, the mean score in the control group was higher (10.4 ± 0.6) than in the MwA and MwoA patients (P < 0.001). The mean BSIT® score did not differ significantly between patients with and without odor-triggered migraine attacks (9 ± 0.9 and 8.8 ± 0.8, respectively) (P = 0.4). Osmophobia and odor-triggered attacks were more common in the MwA patients than in the MwoA patients (odor-triggered attacks: 66% vs. 40% [P = 0.04]; osmophobia: 76.6% vs. 60% [P = 0.16]) CONCLUSION: Olfactory acuity is lower during attack-free periods in migraine patients, as compared to controls. Migraine aura status does not affect olfactory acuity. Odor-triggered attacks, osmophobia, and offensive odors between attacks were more common in the MwA patients than in the MwoA patients.
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Affiliation(s)
- Süheyla Kandemir
- Kırıkkale Yüksek İhtisas Hospital, Department of Otorhinolaryngology, Kırıkkale 71400, Turkey
| | - A Erim Pamuk
- Kırıkkale Yüksek İhtisas Hospital, Department of Otorhinolaryngology, Kırıkkale 71400, Turkey.
| | - Yasin Habipoğlu
- Kırıkkale Yüksek İhtisas Hospital, Department of Neurology, Kırıkkale, Turkey
| | - Gökçe Özel
- Kırşehir Ahi Evran University , Faculty of Medicine, Department of Otorhinolaryngology, Kırşehir, Turkey
| | - Nuray Bayar Muluk
- Kırıkkale University, Faculty of Medicine, Department of Otorhinolaryngology, Kırıkkale, Turkey
| | - Rahmi Kılıç
- Ankara Training and Research Hospital, Department of Otorhinolaryngology, Ankara, Turkey
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Tanik N, Bektas M. Development of quality of life assessment questionnaire associated with osmophobia in people with migraine. PAIN MEDICINE 2021; 23:1006-1014. [PMID: 34672350 DOI: 10.1093/pm/pnab314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/25/2021] [Accepted: 10/01/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND It is important to implement disease-specific precautions to develop quality of life in migraine. The effect of osmophobia, which is one of the specific symptoms of migraine that might help to differentiate migraine from other headache disorders, on quality of life is unknown. The aim of the present study was to develop a practicable and reliable scale that assesses the effect of osmophobia on quality of life in migraine. METHODS This cross-sectional study was carried out with 163 patients with migraine and 110 healthy individuals for control group. The scale items were constructed based on after literature review, expert opinions, and preliminary trial stage. A semi-structured interview was conducted with the patients by the Neurologist to evaluate the presence of osmophobia retrospectively. Migraine osmophobia-related quality of life assessment (MORA) consisted of 6 items including personal care, eating or cooking, house cleaning, close relationship, social life and traveling. RESULTS The Cronbach's α coefficient was 0.86; and the Guttman split-half coefficient was 0.83. Receiver operating characteristic analysis showed an area under the curve of 0.943 (95%) confidence interval [CI] = 0.902-0.984), a cut off score of > 9.5, a sensitivity of 91.6%, a specificity of 85.7%. Mean scores of the MORA differed between people with migraine (with and without osmophobia) and healthy controls (<0.001). CONCLUSION MORA is a valid and reliable self-report questionnaire that assesses the effect of osmophobia on quality of life in migraine. This questionnaire appears to be practicable diagnostic instrument in clinical practice and research.
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Affiliation(s)
- Nermin Tanik
- Assoc. Prof. MD, Yozgat Bozok University Medical School, Department of Neurology, Yozgat, Turkey
| | - Murat Bektas
- Prof. PhD, RN, Dokuz Eylul University, Faculty of Nursing, Izmir, Turkey
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Doğan A, Bayar Muluk N, Şahan MH, Asal N, Inal M, Ergün U. Olfactory bulbus volume and olfactory sulcus depth in migraine patients: an MRI evaluation. Eur Arch Otorhinolaryngol 2018; 275:2005-2011. [DOI: 10.1007/s00405-018-5029-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/02/2018] [Indexed: 02/07/2023]
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Viana M, Bottiroli S, Sances G, Ghiotto N, Allena M, Guaschino E, Nappi G, Tassorelli C. Factors associated to chronic migraine with medication overuse: A cross-sectional study. Cephalalgia 2018; 38:2045-2057. [PMID: 29635935 DOI: 10.1177/0333102418761047] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM Factors implicated in the evolution of episodic migraine into chronic migraine are largely elusive. Medication overuse is considered to be one of the main determinants, but other possible clinical and psychological factors can play a role. The aim of this study is to identify factors that are associated with chronic migraine with medication overuse. METHOD We enrolled consecutive migraine patients, subdividing them in two groups: Subjects with a long history of episodic migraine and subjects with chronic migraine and medication overuse. We then compared their clinical and psychological variables in a cross-sectional study. RESULTS Three hundred and eighteen patients were enrolled, of which 156 were episodic migraine and 162 were chronic migraine and medication overuse patients. The mean age was 42.1 ± 10.3, 80.8% were female. The duration of migraine was 24.6 years in episodic migraine and 24.0 years in chronic migraine and medication overuse ( p = 0.57). After the multivariate analysis, the factors associated to chronic migraine and medication overuse were: Marital status (married vs. unmarried, OR 3.65, 95% CI 1.63-8.19, p = 0.002; separated/divorced/widowed vs. unmarried, OR 4.19, 95% CI 1.13-15.47, p = 0.031), physical activity (OR 0.42, 95% CI 0.19-0.91, p = 0.029), age at onset of migraine (OR 0.94, 95% CI 0.89-0.98, p = 0.016), use of at least one migraine preventive medication (OR 2.36, 95% CI 1.18-4.71, p = 0.014), history of depression (OR 2.91, 95% CI 1.25-6.73, p = 0.012), insomnia associated with the use of hypnotics (OR 5.59, 95% CI 1.65-18.93, p = 0.006), traumatic head injuries (OR 3.54, 95% CI 1.57-7.99, p = 0.002), snoring (OR 2.24, 95% CI 1.05-4.79, p = 0.036), previous and/or actual use of combined oral contraceptives (OR 3.38, 95% CI 1.10-10.3, p = 0.031) and higher scores in the Childhood Trauma questionnaire (OR 1.48, 95% CI 1.09-2.02, p = 0.012). CONCLUSION We considered several aspects that may be involved in the development of chronic migraine and medication overuse. A multivariate analysis identified 10 factors belonging to five different areas, to suggest that chronic migraine and medication overuse onset is likely influenced by a complex mixture of factors. This information is useful when planning strategies to prevent and manage chronic migraine and medication overuse.
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Affiliation(s)
- Michele Viana
- 1 Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Sara Bottiroli
- 1 Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Grazia Sances
- 1 Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Natascia Ghiotto
- 1 Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Marta Allena
- 1 Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Elena Guaschino
- 1 Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Giuseppe Nappi
- 1 Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- 1 Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.,2 Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Wang JJ, Chen J, Doty RL. Impact of antibiotics on smell dysfunction. World J Otorhinolaryngol Head Neck Surg 2018; 4:33-38. [PMID: 30035259 PMCID: PMC6051305 DOI: 10.1016/j.wjorl.2018.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 03/02/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Viral or bacterial respiratory infections can cause long-lasting olfactory dysfunction. Antibiotic therapy is indicated in severe cases; however, it is unclear whether antibiotic use produces a positive, negative, or null effect on olfactory function. This retrospective study sought to determine whether antibiotic use has an influence on odor identification and detection threshold test scores of patients with smell dysfunction secondary to upper respiratory infections (URIs), lower respiratory infections (LRIs), or rhinosinusitis. METHODS Data from a total of 288 patients presenting to the University of Pennsylvania Smell and Taste Center were evaluated. RESULTS Patients with a URI etiology who had taken bactericidal antibiotics had lower detection thresholds than did patients who had not taken antibiotics (P < 0.023; analysis of covariance with age and time since infection onset as covariates). Moreover, thresholds were lower for bactericidal antibiotic users than for bacteriostatic antibiotic users with either URI (P = 0.023) or rhinosinusitis (P = 0.028) etiologies. No meaningful influences of antibiotics on the odor identification test scores were evident. CONCLUSIONS These findings, which need to be confirmed in prospective double-blind studies, suggest that bactericidal antibiotic therapy may be beneficial in mitigating, at least to some degree, chronic decrements in smell sensitivity due to URIs and rhinosinusitis.
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Affiliation(s)
- Jing-Jie Wang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, China
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan, China
| | - Jonathan Chen
- Smell and Taste Center, Department of Otorhinolaryngology – Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Richard L. Doty
- Smell and Taste Center, Department of Otorhinolaryngology – Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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