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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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Efendioğlu MK, Orhan EK, Şen C, Sönmez S, Orhan KS, Baykan B. Olfactory function assessment of migraine patients by using the Sniffin' sticks test: A clinical study. Am J Otolaryngol 2024; 45:104076. [PMID: 37832332 DOI: 10.1016/j.amjoto.2023.104076] [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: 08/19/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE This as a cross-sectional controlled clinical study. We hypothesis that the olfactory functions in migraine patients may differ from the healthy controls. In this study, we evaluated the olfactory functions by using a Sniffin' Sticks test battery, which is a reliable and semi quantitative test to evaluate for olfactory dysfunction. METHODS Patients above 18 years of age who had migraine received a definitive diagnosis of migraine from experienced headache specialists based on the criteria of The International Classification of Headache Disorders-3 were included. Odor threshold, discrimination, and identification parameters were assessed using the "Sniffin' Sticks" test. RESULTS One-hundred and one migraine patients (age [mean ± SD], 36.9 ± 10.4 years; range, 18-60 years) and sixty healthy volunteers (age 34.5 ± 13.2 years, range 18-65 years) participated in our study. The median odor threshold score [percentiles 25th-75th] was 8.3 [6.5-9.8] for the migraine group during attack free period and 4.5[3.6-6.0] for the control group. It was found that the migraine group had a median odor discrimination score of 10.0 [10.0-13.0] and the control group 12.0 [11.0-13.0]. These differences were statistically significant (p < 0.001 and p = 0.032 respectively). The median odor discrimination and identification scores were statistically significant higher for the participants with higher educational level group than in those of lower educational group (p < 0.0001). The median odor discrimination and identification scores of those without allodynia (12.0 [10.0-14.0] and 13.0 [10.0-13.0] respectively) were higher than that of those with allodynia (11.0 [9.0-12.0] and 11.0 [10.0-13.0] respectively) (p = 0.037 and p = 0.034 respectively). CONCLUSIONS We found that the odor thresholds, discrimination and identification scores of the migraine group demonstrate differences from those of the healthy group and in relation to allodynia.
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Affiliation(s)
- Merih Karbay Efendioğlu
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Elif Kocasoy Orhan
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Cömert Şen
- Istanbul University, Istanbul Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey
| | - Said Sönmez
- Istanbul University, Istanbul Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey.
| | - Kadir Serkan Orhan
- Istanbul University, Istanbul Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey
| | - Betül Baykan
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
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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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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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Cycling multisensory changes in migraine: more than a headache. Curr Opin Neurol 2022; 35:367-372. [PMID: 35674081 DOI: 10.1097/wco.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Research on migraine usually focuses on the headache; however, accumulating evidence suggests that migraine not only changes the somatosensory system for nociception (pain), but also the other modalities of perception, such as visual, auditory or tactile sense. More importantly, the multisensory changes exist beyond the headache (ictal) phase of migraine and show cyclic changes, suggesting a central generator driving the multiple sensory changes across different migraine phases. This review summarizes the latest studies that explored the cyclic sensory changes of migraine. RECENT FINDINGS Considerable evidence from recent neurophysiological and functional imaging studies suggests that alterations in brain activation start at least 48 h before the migraine headache and outlast the pain itself for 24 h. Several sensory modalities are involved with cyclic changes in sensitivity that peak during the ictal phase. SUMMARY In many ways, migraine represents more than just vascular-mediated headaches. Migraine alters the propagation of sensory information long before the headache attack starts.
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7
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Luo X, Wang X, Du M, Xu X. Dispersive Liquid-Liquid Microextraction Followed by HS-SPME for the Determination of Flavor Enhancers in Seafood Using GC-MS. Foods 2022; 11:foods11101507. [PMID: 35627077 PMCID: PMC9140692 DOI: 10.3390/foods11101507] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/20/2022] [Accepted: 05/20/2022] [Indexed: 02/01/2023] Open
Abstract
The determination of flavor compounds using headspace solid-phase microextraction (HS-SPME) combined with gas chromatography–mass spectrometry (GC-MS) can be severely interfered with by complex food matrices in food systems, especially solid samples. In this study, dispersive liquid-liquid microextraction (DLLME) was applied prior to HS-SPME to efficiently reduce the matrix effect in solid seafood samples. The method had high sensitivity (the quantification limits of maltol and ethyl maltol were 15 and 5 μg/kg, respectively), an excellent linear relationship (R2 ≥ 0.996), and the sample recovery rate was 89.0–118.6%. The relative standard deviation (RSD %) values for maltol and ethyl maltol were lower than 10%. Maltol (from 0.7 to 2.2 μg/g) and ethyl maltol (from 0.9 to 34.7 μg/g) in seafood were detected in the selected samples by the developed method. Finally, DLLME coupled with HS-SPME effectively removed the influence of sample matrix and improved the sensitivity of the method. The developed method was applicable in the analysis of flavor enhancers in complex matrix foods.
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8
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Tu Y, Wang Y, Yuan H, Chen S, Tzeng Y, Chen W, Lai K, Ling Y, Wang S. Most bothersome symptoms in patients with migraine: A hospital‐based study in Taiwan. Headache 2022; 62:596-603. [DOI: 10.1111/head.14308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Yi‐Hsien Tu
- Department of Neurology National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University Tainan Taiwan
- Department of Neurology E‐Da Hospital I‐Shou University Kaohsiung Taiwan
| | - Yen‐Feng Wang
- School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Department of Neurology Neurological Institute Taipei Veterans General Hospital Taipei Taiwan
- Brain Research Center and College of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
| | - Hsiangkuo Yuan
- Jefferson Headache Center, Department of Neurology Thomas Jefferson University Philadelphia Pennsylvania USA
| | - Shih‐Pin Chen
- School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Department of Neurology Neurological Institute Taipei Veterans General Hospital Taipei Taiwan
- Brain Research Center and College of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Institute of Clinical Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Division of Translational Research Department of Medical Research Taipei Veterans General Hospital Taipei Taiwan
| | - Yi‐Shiang Tzeng
- Department of Neurology Neurological Institute Taipei Veterans General Hospital Taipei Taiwan
| | - Wei‐Ta Chen
- School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Department of Neurology Neurological Institute Taipei Veterans General Hospital Taipei Taiwan
- Brain Research Center and College of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
| | - Kuan‐Lin Lai
- School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Department of Neurology Neurological Institute Taipei Veterans General Hospital Taipei Taiwan
| | - Yu‐Hsiang Ling
- School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Department of Neurology Neurological Institute Taipei Veterans General Hospital Taipei Taiwan
| | - Shuu‐Jiun Wang
- School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Department of Neurology Neurological Institute Taipei Veterans General Hospital Taipei Taiwan
- Brain Research Center and College of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
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9
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Patel ZM, Holbrook EH, Turner JH, Adappa ND, Albers MW, Altundag A, Appenzeller S, Costanzo RM, Croy I, Davis GE, Dehgani-Mobaraki P, Doty RL, Duffy VB, Goldstein BJ, Gudis DA, Haehner A, Higgins TS, Hopkins C, Huart C, Hummel T, Jitaroon K, Kern RC, Khanwalkar AR, Kobayashi M, Kondo K, Lane AP, Lechner M, Leopold DA, Levy JM, Marmura MJ, Mclelland L, Miwa T, Moberg PJ, Mueller CA, Nigwekar SU, O'Brien EK, Paunescu TG, Pellegrino R, Philpott C, Pinto JM, Reiter ER, Roalf DR, Rowan NR, Schlosser RJ, Schwob J, Seiden AM, Smith TL, Soler ZM, Sowerby L, Tan BK, Thamboo A, Wrobel B, Yan CH. International consensus statement on allergy and rhinology: Olfaction. Int Forum Allergy Rhinol 2022; 12:327-680. [PMID: 35373533 DOI: 10.1002/alr.22929] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/01/2021] [Accepted: 11/19/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The literature regarding clinical olfaction, olfactory loss, and olfactory dysfunction has expanded rapidly over the past two decades, with an exponential rise in the past year. There is substantial variability in the quality of this literature and a need to consolidate and critically review the evidence. It is with that aim that we have gathered experts from around the world to produce this International Consensus on Allergy and Rhinology: Olfaction (ICAR:O). METHODS Using previously described methodology, specific topics were developed relating to olfaction. Each topic was assigned a literature review, evidence-based review, or evidence-based review with recommendations format as dictated by available evidence and scope within the ICAR:O document. Following iterative reviews of each topic, the ICAR:O document was integrated and reviewed by all authors for final consensus. RESULTS The ICAR:O document reviews nearly 100 separate topics within the realm of olfaction, including diagnosis, epidemiology, disease burden, diagnosis, testing, etiology, treatment, and associated pathologies. CONCLUSION This critical review of the existing clinical olfaction literature provides much needed insight and clarity into the evaluation, diagnosis, and treatment of patients with olfactory dysfunction, while also clearly delineating gaps in our knowledge and evidence base that we should investigate further.
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Affiliation(s)
- Zara M Patel
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Eric H Holbrook
- Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Justin H Turner
- Otolaryngology, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Nithin D Adappa
- Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark W Albers
- Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aytug Altundag
- Otolaryngology, Biruni University School of Medicine, İstanbul, Turkey
| | - Simone Appenzeller
- Rheumatology, School of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Richard M Costanzo
- Physiology and Biophysics and Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Ilona Croy
- Psychology and Psychosomatic Medicine, TU Dresden, Dresden, Germany
| | - Greg E Davis
- Otolaryngology, Proliance Surgeons, Seattle and Puyallup, Washington, USA
| | - Puya Dehgani-Mobaraki
- Associazione Naso Sano, Umbria Regional Registry of Volunteer Activities, Corciano, Italy
| | - Richard L Doty
- Smell and Taste Center, Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Valerie B Duffy
- Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | | | - David A Gudis
- Otolaryngology, Columbia University Irving Medical Center, New York, USA
| | - Antje Haehner
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | - Thomas S Higgins
- Otolaryngology, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Claire Hopkins
- Otolaryngology, Guy's and St. Thomas' Hospitals, London Bridge Hospital, London, UK
| | - Caroline Huart
- Otorhinolaryngology, Cliniques universitaires Saint-Luc, Institute of Neuroscience, Université catholgique de Louvain, Brussels, Belgium
| | - Thomas Hummel
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | | | - Robert C Kern
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashoke R Khanwalkar
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Masayoshi Kobayashi
- Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Kenji Kondo
- Otolaryngology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Andrew P Lane
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matt Lechner
- Otolaryngology, Barts Health and University College London, London, UK
| | - Donald A Leopold
- Otolaryngology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Joshua M Levy
- Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael J Marmura
- Neurology Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lisha Mclelland
- Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Takaki Miwa
- Otolaryngology, Kanazawa Medical University, Ishikawa, Japan
| | - Paul J Moberg
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Sagar U Nigwekar
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erin K O'Brien
- Otolaryngology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Teodor G Paunescu
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Carl Philpott
- Otolaryngology, University of East Anglia, Norwich, UK
| | - Jayant M Pinto
- Otolaryngology, University of Chicago, Chicago, Illinois, USA
| | - Evan R Reiter
- Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - David R Roalf
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nicholas R Rowan
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rodney J Schlosser
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - James Schwob
- Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Allen M Seiden
- Otolaryngology, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Timothy L Smith
- Otolaryngology, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Zachary M Soler
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - Leigh Sowerby
- Otolaryngology, University of Western Ontario, London, Ontario, Canada
| | - Bruce K Tan
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrew Thamboo
- Otolaryngology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bozena Wrobel
- Otolaryngology, Keck School of Medicine, USC, Los Angeles, California, USA
| | - Carol H Yan
- Otolaryngology, School of Medicine, UCSD, La Jolla, California, USA
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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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Delussi M, Laporta A, Fraccalvieri I, de Tommaso M. Osmophobia in primary headache patients: associated symptoms and response to preventive treatments. J Headache Pain 2021; 22:109. [PMID: 34537019 PMCID: PMC8449918 DOI: 10.1186/s10194-021-01327-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/07/2021] [Indexed: 12/26/2022] Open
Abstract
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. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-021-01327-2.
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Affiliation(s)
- Marianna Delussi
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Aldo Moro University, Bari, Italy
| | - Anna Laporta
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Aldo Moro University, Bari, Italy
| | - Ilaria Fraccalvieri
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Aldo Moro University, Bari, Italy
| | - Marina de Tommaso
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Aldo Moro University, Bari, Italy.
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Mathew PG, Krivitski D, Sharon R. Erenumab-Induced Severe Nausea Leading to Smoking Cessation: A Retrospective Case Series. Headache 2020; 60:2563-2569. [PMID: 33202039 DOI: 10.1111/head.13979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/15/2020] [Accepted: 08/29/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Erenumab is a novel treatment modality with a relatively benign and safe side effect profile, currently approved for the prevention of migraine headache. We present 3 cases with chronic migraine who are cigarette smokers were prescribed erenumab, and developed an intense smoking-induced nausea which eventually led to smoking cessation. METHODS A multicenter retrospective review of 3 cases with cigarette smoking, one of whom was also smoking marijuana, suffering from chronic migraine resistant to multiple preventive therapies was studied. All were prescribed monthly injections of erenumab 70 mg. Response in terms of headache frequency and intensity and smoking habits was obtained through medical record review. RESULTS Out of 3 patients, 2 reported reduced headache frequency and intensity. All patients developed severe nausea while smoking cigarettes after their first dose of erenumab, leading to smoking cessation. One patient co-smoked marijuana, which did not result in nausea after being treated. CONCLUSION To the best of our knowledge, this is the first report of severe nausea secondary to erenumab administration and smoking cigarettes, which finally resulted in complete cigarette smoking cessation. As such, further study is indicated on the benefit of erenumab and other calcitonin gene-related peptide antagonists in migraineurs who smoke to promote smoking cessation.
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Affiliation(s)
- Paul G Mathew
- Department of Neurology, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Harvard Vanguard Medical Associates, Braintree, MA, USA
| | - David Krivitski
- Department of General, Yitzhak Shamir Medical Center, Be'er Ya'akov, Israel
| | - Roni Sharon
- Department of Neurology, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel
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Sousa-Santos PM, Moura CGF, Fontenele JL, Lima NDC, Santos RA, Silva-Néto RP. Headache and Osmophobia in Gas Station Workers Exposed to Gasoline Odor. Eur Neurol 2020; 83:259-262. [PMID: 32721978 DOI: 10.1159/000508365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/02/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Headache attacks may be triggered by several factors, among them odors, especially in migraine patients. OBJECTIVES The aim of this study wasto determine the association between gasoline odor and headache attacks in patients with migraine or tension-type headache (TTH). SUBJECTS AND METHODS The study was prospective, cross-sectional, with comparison of groups, using nonrandom sample and convenience. Fifty-two gas station workers diagnosed with migraine or TTH according to ICHD-3 criteria were interviewed on the relationship between gasoline odor and headache. RESULTS Of the 52 gas station workers with headaches, there were 39 (75%) with migraine without aura and 13 (25%) with TTH. The age ranged from 19 to 50 years, with a mean of 29.5 ± 7.2 years. Osmophobia during headache attacks predominated in workers with migraine (29/39; 74.4%). The onset of headache due to odor exposure occurred in 23/39 (60%) of the workers with migraine and in 2/13 (15.4%) in TTH. These differences were statistically significant (χ2 = 7.4; p = 0.016). Osmophobia in the absence of pain (period between attacks) predominated in workers with migraine (17/39, 43.6%), but with no statistical value. CONCLUSIONS Gas station workers diagnosed with migraine or TTH may experience osmophobia and headache triggered by the odor of gasoline.
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Danno D, Wolf J, Ishizaki K, Kikui S, Yoshikawa H, Takeshima T. Cranial Autonomic Symptoms of Migraine in Japan: Prospective Study of 373 Migraine Patients at a Tertiary Headache Center. Headache 2020; 60:1592-1600. [DOI: 10.1111/head.13888] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 05/22/2020] [Accepted: 05/22/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Daisuke Danno
- Headache Center Department of Neurology Tominaga Hospital Osaka Japan
| | - Johanna Wolf
- Division of Neurology Department of Internal Medicine Hyogo College of Medicine Hyogo Japan
| | - Kumiko Ishizaki
- Headache Center Department of Neurology Tominaga Hospital Osaka Japan
| | - Shoji Kikui
- Headache Center Department of Neurology Tominaga Hospital Osaka Japan
| | | | - Takao Takeshima
- Headache Center Department of Neurology Tominaga Hospital Osaka Japan
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Abstract
Migraine encompasses a broader spectrum of sensory symptoms than just headache. These "other" symptoms, eg, sensory phobias, cognitive and mood changes, allodynia, and many others indicate an altered sensitivity to sensory input which can be measured, in principle, by quantifying sensory threshold changes longitudinally over time. Photophobia, for example, can be quantified by investigating the discomfort thresholds towards the luminance of light. The aim of this review is to look into how thresholds change in patients with migraine. We performed a PubMed search up to June 2018 targeting all peer-reviewed articles evaluating the changes in threshold, sensory phobia, or sensitivity in patients with migraine. Migraineurs, in general, exhibit lower sensory thresholds compared with healthy controls. These threshold changes seem to follow the different phases during a migraine cycle. In general, thresholds reach a nadir when the headache starts (the ictal phase), rise after the headache ends, and then gradually descend towards the next attack. The sensory modality of measurement-mechanical, thermal, or nociceptive-and the location of measurement-trigeminal vs somatic dermatome-also influence the sensory threshold. Functional imaging studies provide evidence that the hypothalamo-thalamo-brainstem network may be the driving force behind the periodic threshold changes. In summary, there is evidence in the literature that migraine could be understood as a periodic sensory dysregulation originating from the brain. Nevertheless, the interstudy discrepancy is still high due to different study designs and a lack of focus on distinct migraine phases. Further well-designed and harmonized studies with an emphasis on the cyclic changes still need to be conducted.
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Albanês Oliveira Bernardo A, Lys Medeiros F, Sampaio Rocha‐Filho PA. Osmophobia and Odor‐Triggered Headaches in Children and Adolescents: Prevalence, Associated Factors, and Importance in the Diagnosis of Migraine. Headache 2020; 60:954-966. [DOI: 10.1111/head.13806] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 01/24/2023]
Affiliation(s)
- Albérico Albanês Oliveira Bernardo
- Postgraduate Program in Neuropsychiatry and Behavioral Sciences Federal University of Pernambuco Recife Brazil
- Pelopidas Silveira Hospital Recife Brazil
| | - Fabiola Lys Medeiros
- Children’s Headache Clinic Oswaldo Cruz University Hospital University of Pernambuco Recife Brazil
| | - Pedro Augusto Sampaio Rocha‐Filho
- Department of Neuropsychiatry Federal University of Pernambuco Recife Brazil
- Headache Clinic Oswaldo Cruz University Hospital University of Pernambuco Recife Brazil
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Dispersive solid-phase extraction and dispersive liquid–liquid microextraction for the determination of flavor enhancers in ready-to-eat seafood by HPLC-PDA. Food Chem 2020; 309:125753. [DOI: 10.1016/j.foodchem.2019.125753] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 09/26/2019] [Accepted: 10/19/2019] [Indexed: 01/31/2023]
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Terrin A, Mainardi F, Lisotto C, Mampreso E, Fuccaro M, Maggioni F, Zanchin G. A prospective study on osmophobia in migraine versus tension-type headache in a large series of attacks. Cephalalgia 2019; 40:337-346. [DOI: 10.1177/0333102419877661] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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.
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Affiliation(s)
- Alberto Terrin
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Federico Mainardi
- Headache Centre, Neurological Division, SS. Giovanni e Paolo Hospital, Venezia, Italy
| | - Carlo Lisotto
- Headache Centre, Department of Neurology, Azienda Sanitaria n. 5 Friuli Occidentale, Pordenone, Italy
| | - Edoardo Mampreso
- Headache Centre, Neurology – Euganea – Padova Health Unit, Padova, Italy
| | | | | | - Giorgio Zanchin
- Department of Neuroscience, University of Padova, Padova, Italy
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Oguz Akarsu E, Baykan B, Ertas M, Zarifoglu M, Orhan EK, Saip S, Siva A, Karli N. The persistence versus interchangeability of migraine and tension-type headaches in a 5-year population-based validated survey. Cephalalgia 2019; 40:39-48. [PMID: 31161955 DOI: 10.1177/0333102419852359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this population-based validated study was to determine the course of tension-type headache and migraine and to evaluate the predictors of persistence. METHODS We evaluated the course of headache in a large population from the first assessment in 2008 through a second assessment in 2013. Then we examined the factors associated with persistent migraine and persistent tension-type headache. RESULTS Our study in 2013 revealed that only 42.9% of definite migraineurs in 2008 received the same diagnosis again, and of the remaining migraineurs 23.3% were newly diagnosed as definite tension-type headache; 11.6% evolved into probable tension-type headache, 6.4% changed to probable migraine, and 15.8% were headache free. The 17.7% of patients with definite tension-type headache in 2008 were newly diagnosed as having probable tension-type headache, 14.7% as having definite migraine, 6.4% as having probable migraine, and 28.9% as headache free in 2013, and only 32.3% received the definite tension-type headache diagnosis again. Binary logistic regression analysis showed nausea, throbbing and severe headache were the significant parameters for persistent migraine. A multiple regression analysis model with stepwise variable selection revealed that nausea, throbbing and severe headache and osmophobia remained in the final model as predictors of migraine persistence. We found no predictive factor for persistent tension-type headache. CONCLUSION Migraine and tension-type headache did not seem to show a simple bidirectional linear worsening from headache-free state to definite migraine or vice versa, hence the transitions between them are more chaotic, reflecting that there are still unknown modifiers and modulators. Certain headache characteristics of migraine might predict persistent migraine.
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Affiliation(s)
- Emel Oguz Akarsu
- Department of Neurology, Uludag School of Medicine, Uludag University, Bursa, Turkey
| | - Betul Baykan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Ertas
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Zarifoglu
- Department of Neurology, Uludag School of Medicine, Uludag University, Bursa, Turkey
| | - Elif Kocasoy Orhan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sabahattin Saip
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Aksel Siva
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Necdet Karli
- Department of Neurology, Uludag School of Medicine, Uludag University, Bursa, Turkey
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Ozan ZT, Tanik N, Inan LE. Constipation is associated with tension type headache in women. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:161-165. [DOI: 10.1590/0004-282x20190015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/27/2018] [Indexed: 02/07/2023]
Abstract
ABSTRACT Tension-type headaches (TTH) and irritable bowel syndrome (IBS) are comorbid diseases affecting, especially, women. One of the underlying mechanisms for both is autonomic dysfunction in the brain-gut axis. We aimed to evaluate the factors accompanying TTH and their relation to functional gastrointestinal disorders. Methods: Women diagnosed with TTH were questioned about headache pattern and severity, and accompanying factors, as well as being screened for IBS according to the Rome III criteria. The participants were divided into two groups: constipation-dominant IBS (IBS-C) group and “others”, with a total of 115 individuals included in the study. Results: Of the 115 patients; 48 (41.8%) of the women had IBS-C criteria while 67 (58.2%) described mixed-type IBS or diarrhea-dominant IBS. There were no significant differences in terms of mean age (p = 0.290), body mass index (p = 0.212), visual analog scale (p = 0.965), duration of attacks (p = 0.692), and episodic/chronic type (p = 0.553). Osmophobia was seen in 43.5%; phonophobia in 68.7%, and photophobia in 47.0% of the patients, and only osmophobia was significantly associated in women in the IBS-C group (p = 0.001). Conclusion: In female patients with TTH, a higher level of constipation was detected. The relationship of these two diseases suggests that they may share common mechanisms. This is the first study showing the relationship of osmophobia with constipation.
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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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Chalmer MA, Hansen TF, Olesen J. Nosographic analysis of osmophobia and field testing of diagnostic criteria including osmophobia. Cephalalgia 2018; 39:38-43. [PMID: 29665696 DOI: 10.1177/0333102418771375] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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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Affiliation(s)
- Mona Ameri Chalmer
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Glostrup, Denmark
| | - Thomas Folkmann Hansen
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Glostrup, Denmark
| | - Jes Olesen
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Glostrup, Denmark
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Affiliation(s)
- Parisa Gazerani
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Brian Edwin Cairns
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
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Abstract
PURPOSE OF REVIEW This review aims to provide an overview of the most recent and significant functional neuroimaging studies which have clarified the complex mechanisms underlying migraine pathophysiology. RECENT FINDINGS The recent data allow us to overcome the concept of a migraine generator suggesting that functional networks abnormalities may lead to changes in different brain area activities and consequent reduced migraine thresholds susceptibility, likely associated with higher migraine severity and burden. Although functional magnetic resonance imaging studies have allowed recognition of several migraine mechanisms, its pathophysiology is not completely understood and is still a matter of research. Nevertheless, in recent years, functional magnetic resonance imaging studies have allowed us to implement our knowledge of migraine pathophysiology. The pivotal role of both the brainstem and the hippocampus in the first phase of a migraine attack, the involvement of limbic pathway in the constitution of a migrainous pain network, the disrupted functional connectivity in cognitive brain networks, as well as the abnormal function of the visual network in patients with migraine with aura are the main milestones in migraine imaging achieved through functional imaging advances. We believe that further studies based on combined functional and structural techniques and the investigation of the different phases of migraine cycle may represent an efficient methodological approach for comprehensively looking into the migrainous brain secrets.
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Chitsaz A, Ghorbani A, Dashti M, Khosravi M, Kianmehr M. The Prevalence of Osmophobia in Migranous and Episodic Tension Type Headaches. Adv Biomed Res 2017; 6:44. [PMID: 28503499 PMCID: PMC5414411 DOI: 10.4103/2277-9175.204587] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Migraines are a neurological disease, of which the most common symptom is an intense and disabling episodic headache. Many persons experience sensory hyper excitability manifested by photophobia, phonophobia and osmophobia. This study was planned to investigate the prevalence of osmophobia in migranous and episodic tension type headache (ETTH). Materials and Methods: A semi-structured questionnaire was administered to all patients to evaluate the eventual presence of osmophobia during a headache attack and different characteristics of osmophobia were determined. Results: Osmophobia reported in 84% with migranous headache with aura, 74% of migranous patients without aura and in 43.3% of those with ETTH. In 50% of patients, osmophobia was present in all of their headache attacks, 11.7% had osmophobia in more than half of their attacks (from 10 attacks they reported osmophobia in 5-9 ones) and others had this sign in less than half of their attacks (from 10 attacks they reported osmophobia in less than 5 ones). Most frequently the offending odors were scents (88%), foods (54.2%) and cigarette smoke (62.5%). Osmophobia starts 30 min before the headache starts in 22.7% of patients. Conclusion: Osmophobia appears structurally integrated into the migraine history of the patient; however, for differential diagnosis with ETTH, other criteria are necessary.
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Affiliation(s)
- Ahmad Chitsaz
- Department of Neurology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbas Ghorbani
- Department of Neurology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Dashti
- Department of Neurology, Mohammad Rasolalah Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Khosravi
- General Practitioner, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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Goadsby PJ, Holland PR, Martins-Oliveira M, Hoffmann J, Schankin C, Akerman S. Pathophysiology of Migraine: A Disorder of Sensory Processing. Physiol Rev 2017; 97:553-622. [PMID: 28179394 PMCID: PMC5539409 DOI: 10.1152/physrev.00034.2015] [Citation(s) in RCA: 1027] [Impact Index Per Article: 146.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Plaguing humans for more than two millennia, manifest on every continent studied, and with more than one billion patients having an attack in any year, migraine stands as the sixth most common cause of disability on the planet. The pathophysiology of migraine has emerged from a historical consideration of the "humors" through mid-20th century distraction of the now defunct Vascular Theory to a clear place as a neurological disorder. It could be said there are three questions: why, how, and when? Why: migraine is largely accepted to be an inherited tendency for the brain to lose control of its inputs. How: the now classical trigeminal durovascular afferent pathway has been explored in laboratory and clinic; interrogated with immunohistochemistry to functional brain imaging to offer a roadmap of the attack. When: migraine attacks emerge due to a disorder of brain sensory processing that itself likely cycles, influenced by genetics and the environment. In the first, premonitory, phase that precedes headache, brain stem and diencephalic systems modulating afferent signals, light-photophobia or sound-phonophobia, begin to dysfunction and eventually to evolve to the pain phase and with time the resolution or postdromal phase. Understanding the biology of migraine through careful bench-based research has led to major classes of therapeutics being identified: triptans, serotonin 5-HT1B/1D receptor agonists; gepants, calcitonin gene-related peptide (CGRP) receptor antagonists; ditans, 5-HT1F receptor agonists, CGRP mechanisms monoclonal antibodies; and glurants, mGlu5 modulators; with the promise of more to come. Investment in understanding migraine has been very successful and leaves us at a new dawn, able to transform its impact on a global scale, as well as understand fundamental aspects of human biology.
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Affiliation(s)
- Peter J Goadsby
- Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; Department of Neurology, University of California, San Francisco, San Francisco, California; Department of Neurology, University of Hamburg-Eppendorf, Hamburg, Germany; and Department of Neurology, University Hospital Bern-Inselspital, University of Bern, Bern, Switzerland
| | - Philip R Holland
- Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; Department of Neurology, University of California, San Francisco, San Francisco, California; Department of Neurology, University of Hamburg-Eppendorf, Hamburg, Germany; and Department of Neurology, University Hospital Bern-Inselspital, University of Bern, Bern, Switzerland
| | - Margarida Martins-Oliveira
- Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; Department of Neurology, University of California, San Francisco, San Francisco, California; Department of Neurology, University of Hamburg-Eppendorf, Hamburg, Germany; and Department of Neurology, University Hospital Bern-Inselspital, University of Bern, Bern, Switzerland
| | - Jan Hoffmann
- Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; Department of Neurology, University of California, San Francisco, San Francisco, California; Department of Neurology, University of Hamburg-Eppendorf, Hamburg, Germany; and Department of Neurology, University Hospital Bern-Inselspital, University of Bern, Bern, Switzerland
| | - Christoph Schankin
- Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; Department of Neurology, University of California, San Francisco, San Francisco, California; Department of Neurology, University of Hamburg-Eppendorf, Hamburg, Germany; and Department of Neurology, University Hospital Bern-Inselspital, University of Bern, Bern, Switzerland
| | - Simon Akerman
- Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; Department of Neurology, University of California, San Francisco, San Francisco, California; Department of Neurology, University of Hamburg-Eppendorf, Hamburg, Germany; and Department of Neurology, University Hospital Bern-Inselspital, University of Bern, Bern, Switzerland
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Bosetti FM, Rossi R, Repici M, Garrone C, Lauria B, Castagno E, Versace A, Grasso G, Pagliero R. P069. Osmophobia in children with headache. J Headache Pain 2017; 16:A76. [PMID: 28132312 PMCID: PMC4759248 DOI: 10.1186/1129-2377-16-s1-a76] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Francesca M Bosetti
- Centro Cefalee dell'Età Evolutiva, SC Pediatria d'Urgenza OIRM, AO Città della Salute e della Scienza, Turin, Italy
| | - Roberta Rossi
- Centro Cefalee dell'Età Evolutiva, SC Pediatria d'Urgenza OIRM, AO Città della Salute e della Scienza, Turin, Italy
| | - Marialia Repici
- Centro Cefalee dell'Età Evolutiva, SC Pediatria d'Urgenza OIRM, AO Città della Salute e della Scienza, Turin, Italy
| | - Corinna Garrone
- Centro Cefalee dell'Età Evolutiva, SC Pediatria d'Urgenza OIRM, AO Città della Salute e della Scienza, Turin, Italy
| | - Barbara Lauria
- Centro Cefalee dell'Età Evolutiva, SC Pediatria d'Urgenza OIRM, AO Città della Salute e della Scienza, Turin, Italy
| | - Emanuele Castagno
- Centro Cefalee dell'Età Evolutiva, SC Pediatria d'Urgenza OIRM, AO Città della Salute e della Scienza, Turin, Italy
| | - Antonella Versace
- Centro Cefalee dell'Età Evolutiva, SC Pediatria d'Urgenza OIRM, AO Città della Salute e della Scienza, Turin, Italy.
| | - Giulia Grasso
- Centro Cefalee dell'Età Evolutiva, SC Pediatria d'Urgenza OIRM, AO Città della Salute e della Scienza, Turin, Italy
| | - Rosaura Pagliero
- Centro Cefalee dell'Età Evolutiva, SC Pediatria d'Urgenza OIRM, AO Città della Salute e della Scienza, Turin, Italy
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30
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Affiliation(s)
- Giorgio Zanchin
- Interdepartmental Centre for Headache and Drug Abuse, Padua University School of Medicine, Padua, Italy.
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Zanchin G, Fuccaro M, Battistella P, Ermani M, Mainardi F, Maggioni F. A lost track in ICHD 3 beta: A comprehensive review on osmophobia. Cephalalgia 2016; 38:340-352. [DOI: 10.1177/0333102416678390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Osmophobia (Os) has been reported to be much more prevalent in migraine (M) than in other primary headaches, and its high specificity in the differential diagnosis between M and tension-type headache (TTH) has been reported. Os was included in the ICHD II Appendix as a diagnostic criterion of M. It disappeared in ICHD-3 beta. To understand this choice, we reviewed the literature after 2004. Methods This was a systematic review. We searched in PubMed, MEDLINE and Cochrane library for “osmophobia”, “odour/odorphobia AND headache”, “odour/odor hypersensitivity AND headache” and “olfactory hypersensitivity AND headache”. Results 112 papers cited Os as an accompanying symptom of headache; 16 focused on Os in M diagnosis. With the data from 40 articles, we calculated the pooled prevalence of Os in 14,360 patients (2281 pediatric) affected by M (n = 12,496) and TTH (n = 1864). In M, the prevalence was 48.5% (CI 95% 41.4 to 55.8%) in adults and 23.4% (CI 95% 15.7 to 33.4%) in pediatric patients; in TTH, the prevalence was 8.9% (CI 95% 4.6 to 13.5%) in adults and 7.9% (CI 95% 3.3 to 18.1%) in pediatric patients. Ten of these papers allowed us to calculate the sensibility and specificity of Os in differential diagnosis between M and TTH. In adults, the value of specificity was 94.1% (CI 95% 88.9 to 96.9%), and sensitivity was 51.4% (CI 95% 38.4 to 64.2%). In pediatric patients, specificity was 92.0% (CI 95% 81.9 to 96.7%), and sensitivity was 22.1% (CI 95% 10.1 to 41.8%). Conclusion The literature endorses the inclusion of Os among M diagnostic criteria. On this ground, the decision to remove Os from ICHD 3 beta appears unjustified and a revision of this choice is recommended.
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Affiliation(s)
- Giorgio Zanchin
- Interdepartmental Headache Centre, School of Medicine, University of Padua, Padua, Italy
| | - Matteo Fuccaro
- Interdepartmental Headache Centre, School of Medicine, University of Padua, Padua, Italy
| | | | - Mario Ermani
- Interdepartmental Headache Centre, School of Medicine, University of Padua, Padua, Italy
| | - Federico Mainardi
- Headache Centre, Neurological Division, SS Giovanni e Paolo Hospital, Venice, Italy
| | - Ferdinando Maggioni
- Interdepartmental Headache Centre, School of Medicine, University of Padua, Padua, Italy
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32
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Mainardi F, Zanchin G, Maggioni F. Olfactory Aura: A Missing Tool? Headache 2016; 56:1670. [DOI: 10.1111/head.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 08/31/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Federico Mainardi
- Headache Centre, Neurological Division; SS GIovanni e Paolo Hospital; Venice Italy
| | - Giorgio Zanchin
- Headache Centre, Department of Neurosciences; Padua University; Padua Italy
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Fornazieri MA, Neto AR, de Rezende Pinna F, Gobbi Porto FH, de Lima Navarro P, Voegels RL, Doty RL. Olfactory symptoms reported by migraineurs with and without auras. Headache 2016; 56:1608-1616. [DOI: 10.1111/head.12973] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/21/2016] [Accepted: 06/22/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | | | | | - Richard L. Doty
- Smell and Test Center; Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA USA
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34
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Silva-Néto RP, Rodrigues ÂB, Cavalcante DC, Ferreira PHPB, Nasi EP, Sousa KMDH, Peres MFP, Valença MM. May headache triggered by odors be regarded as a differentiating factor between migraine and other primary headaches? Cephalalgia 2016; 37:20-28. [DOI: 10.1177/0333102416636098] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives The objective of this article is to characterize olfactory stimulation as a trigger of headaches attacks and differentiation between migraine and other primary headaches. Participants and methods The study was prospective and experimental, with comparison of groups. A total of 158 volunteers (73 men and 85 women) were diagnosed with primary headaches, according to the criteria of the International Classification of Headache Disorders, Third Edition (beta version) (ICHD-3β). The study was conducted by two examiners; one of them was assigned to diagnose the presence and type of primary headache, while the other was responsible for exposing the volunteers to odor and recording the effects of this exposure. Results Of the 158 volunteers with headache, there were 72 (45.6%) cases of migraine and 86 (54.4%) with other primary headaches. In both groups, there were differences in headache characteristics (χ2 = 4.132; p = 0.046). Headache attacks (25/72; 34.7%) and nausea (5/72; 6.9%) were triggered by odor only in patients with migraine, corresponding to 19.0% (30/158) of the sample, but in none with other primary headaches (χ2 = 43.78; p < 0.001). Headache occurred more often associated with nausea ( p = 0.146) and bilateral location ( p = 0.002) in migraineurs who had headache triggered by odor. Headache was triggered after 118 ± 24.6 min and nausea after 72.8 ± 84.7 min of exposure to odor. Conclusions The odor triggered headache attacks or nausea only in migraineurs. Therefore, headache triggered by odors may be considered a factor of differentiation between migraine and other primary headaches and this trigger seems very specific of migraine.
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Mainardi F, Rapoport A, Zanchin G, Maggioni F. Scent of aura? Clinical features of olfactory hallucinations during a migraine attack (OHM). Cephalalgia 2016; 37:154-160. [DOI: 10.1177/0333102416630580] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction Olfactory hallucination during a migraine attack (OHM) is a rare phenomenon. At present, it is not considered a manifestation of migraine aura. Material and methods The clinical features of OHM were collected in 11 patients. Results Of the 11 patients, 10 had migraine without aura and one migraine with aura associated with OHM. Mean age at onset of headache and at appearance of OHM were respectively 17.8 and 32.3 years. Migraine average frequency was 3.9 attacks/month, 19% of them being associated with OHM. The temporal pattern of OHM maintained the same characteristics in the different attacks. OHM onset was described as sudden ( n = 5), gradual ( n = 3), initially sudden and then gradual ( n = 2), or developing in a few seconds ( n = 1). In most of the cases ( n = 8) OHM lasted from 3 to 10 minutes; it persisted during the pain phase (2–24 hours) in only three patients. The type of the perceived smell was invariably constant in nine patients. Conclusion OHM features fulfilled the ICHD-III beta criteria for typical aura.
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Affiliation(s)
- Federico Mainardi
- Headache Centre, Department of Neurology, SS. Giovanni e Paolo Hospital, Venice, Italy
| | | | - Giorgio Zanchin
- Headache Centre, Department of Neurosciences, University of Padua, Italy
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Mainardi F, Maggioni F, Zanchin G. Smell of migraine: Osmophobia as a clinical diagnostic marker? Cephalalgia 2016; 37:906. [DOI: 10.1177/0333102416658710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Federico Mainardi
- Headache Centres, Neurological Division, SS Giovanni e Paolo Hospital, Venice, Italy
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Abstract
PURPOSE OF REVIEW Over the last several years, a growing number of brain functional imaging studies have provided insights into mechanisms underlying migraine. This article reviews the recent migraine functional neuroimaging literature and provides recommendations for future studies that will help fill knowledge gaps. RECENT FINDINGS PET and functional MRI studies have identified brain regions that might be responsible for mediating the onset of a migraine attack and those associated with migraine symptoms. Enhanced activation of brain regions that facilitate processing of sensory stimuli suggests a mechanism by which migraineurs are hypersensitive to visual, olfactory, and cutaneous stimuli. Resting state functional connectivity MRI studies have identified numerous brain regions and functional networks with atypical functional connectivity in migraineurs, suggesting that migraine is associated with aberrant brain functional organization. SUMMARY Functional MRI and PET studies that have identified brain regions and brain networks that are atypical in migraine have helped to describe the neurofunctional basis for migraine symptoms. Future studies should compare functional imaging findings in migraine to other headache and pain disorders and should explore the utility of functional imaging data as biomarkers for diagnostic and treatment purposes.
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Rocha-Filho PAS, Marques KS, Torres RCS, Leal KNR. Migraine, Osmophobia, and Anxiety. PAIN MEDICINE 2015; 17:776-80. [PMID: 26814297 DOI: 10.1093/pm/pnv071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 10/30/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To evaluate the association between osmophobia and the characteristics of patients and their headaches, among migraine patients. METHODS This was a cross-sectional study. Patients who consecutively sought medical attendance in a primary care unit were asked about their headaches over the last 12 months. Those who had migraine were included. A semi-structured interview, the Headache Impact Test and the Hospital Anxiety and Depression Scale were used. RESULTS 147 patients had migraine; 78 had osmophobia; 60 had significant anxiety symptoms; and 78 had significant depression symptoms. The mean age of these patients was 43.2 years (± 13.7); 91.2% were women. The mean length of time with complaints of headache was 13.8 years (± 12). Among the migraine patients, those with anxiety, more years of headache history, and phonophobia presented significantly more osmophobia (multivariate logistic regression). CONCLUSION Osmophobia in migraine patients is associated with significant anxiety symptoms, length of headache history, and phonophobia.
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Affiliation(s)
- Pedro Augusto Sampaio Rocha-Filho
- *Universidade de Pernambuco, Recife, PE, Brazil Department of Neuropsychiatry, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | | | | | - Kamila Nazare Ribas Leal
- *Universidade de Pernambuco, Recife, PE, Brazil Scientific Initiation Fellowships Institutional Program (CNPq)
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Demarquay G, Mauguière F. Central Nervous System Underpinnings of Sensory Hypersensitivity in Migraine: Insights from Neuroimaging and Electrophysiological Studies. Headache 2015; 56:1418-1438. [PMID: 26350583 DOI: 10.1111/head.12651] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2015] [Indexed: 01/03/2023]
Abstract
Whereas considerable data have been generated about the pathophysiology of pain processing during migraine attacks, relatively little is known about the neural basis of sensory hypersensitivity. In migraine, the term "hypersensitivity" encompasses different and probably distinct pathophysiological aspects of sensory sensitivity. During attacks, many patients have enhanced sensitivity to visual, auditory and/or olfactory stimuli, which can enhance headache while interictally, migraineurs often report abnormal sensitivity to environmental stimuli that can cause nonpainful discomfort. In addition, sensorial stimuli can influence and trigger the onset of migraine attacks. The pathophysiological mechanisms and the origin of such sensitivity (individual predisposition to develop migraine disease or consequence of repeated migraine attacks) are ill understood. Functional neuroimaging and electrophysiological studies allow for noninvasive measures of neuronal responses to external stimuli and have contributed to our understanding of mechanisms underlying sensory hypersensitivity in migraine. The purpose of this review is to present pivotal neuroimaging and neurophysiological studies that explored the basal state of brain responsiveness to sensory stimuli in migraineurs, the alterations in habituation and attention to sensory inputs, the fluctuations of responsiveness to sensory stimuli before and during migraine attacks, and the relations between sensory hypersensitivity and clinical sensory complaints.
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Affiliation(s)
- Geneviève Demarquay
- Department of Neurology, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France and Lyon Neuroscience Research Center (CRNL), Brain Dynamics and Cognition Team (Dycog), INSERM U1028, CNRS UMR5292, Lyon, France.
| | - François Mauguière
- Neurological Hospital Pierre Wertheimer: Functional Neurology and Epilepsy Department, Hospices Civils de Lyon and Claude Bernard Lyon1 University, Lyon, France, and Lyon Neuroscience Research Center (CRNL), Neuropain team, INSERM U1028, CNRS UMR5292, Lyon, France
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40
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Rocha-Filho PAS, Marques KS, Torres RCS, Leal KNR. Osmophobia and Headaches in Primary Care: Prevalence, Associated Factors, and Importance in Diagnosing Migraine. Headache 2015; 55:840-5. [DOI: 10.1111/head.12577] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2015] [Indexed: 01/03/2023]
Affiliation(s)
| | | | - Rinailda Cascia Santos Torres
- Universidade de Pernambuco; Recife Brazil
- Scientific Initiation Fellowships Institutional Program (CNPq); Recife Brazil
| | - Kamila Nazare Ribas Leal
- Universidade de Pernambuco; Recife Brazil
- Scientific Initiation Fellowships Institutional Program (CNPq); Recife Brazil
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Rota E, Iafelice I, Morelli N, Ratti G, Guidetti D. Tuberculous leptomeningitis mimicking a migrainous status with osmophobia: a case report. Acta Neurol Belg 2015; 115:177-9. [PMID: 24996870 DOI: 10.1007/s13760-014-0326-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 06/16/2014] [Indexed: 11/26/2022]
Affiliation(s)
- E Rota
- Department of Neurology, Guglielmo da Saliceto Hospital, Via Taverna 49, 29121, Piacenza, Italy,
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Park SP, Seo JG, Lee WK. Osmophobia and allodynia are critical factors for suicidality in patients with migraine. J Headache Pain 2015; 16:529. [PMID: 25968102 PMCID: PMC4434243 DOI: 10.1186/s10194-015-0529-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 05/04/2015] [Indexed: 01/03/2023] Open
Abstract
Background Sensory hypersensitivities are common phenomena in migraine. We examined the role of sensory hypersensitivities on suicidality in patients with migraine. Methods Patients with migraine (with or without aura) were consecutively recruited from our headache clinic. We asked them if they experienced photophobia, phonophobia, osmophobia, and allodynia during migraine attack. The Mini International Neuropsychiatric Interview was used to diagnose current major depressive disorder (MDD), current generalized anxiety disorder (GAD) and suicidality. Results Among 220 subjects, 25.5 % had current MDD, 17.3 % had current GAD, and 31.8 % had suicidality. Patients with suicidality were more like to have a low household income, chronic migraine (CM), medication overuse headache, high headache intensity, osmophobia, allodynia, high disability, MDD, and GAD than those without suicidality. The strongest risk factor for suicidality by multivariate analyses was osmophobia (adjusted Odds Ratio [AOR] 3.12, 95 % confidence interval [CI] 1.57-6.21, p = 0.001), followed by current MDD (AOR 2.99, 95 % CI 1.33-6.76, p = 0.008), CM (AOR 2.48, 95 % CI 1.21-5.09, p = 0.013), current GAD (AOR 3.11, 95 % CI 1.22-7.91, p = 0.017), and allodynia (AOR 2.72, 95 % CI 1.19-6.21, p = 0.018). Conclusions Osmophobia and allodynia are critical factors for suicidality in patients with migraine, after controlling for depression, anxiety, and CM.
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Affiliation(s)
- Sung-Pa Park
- Department of Neurology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 700-842, Republic of Korea,
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Maggioni F, Maggioni U. Allodynia and Osmophobia Proposed in a “Case Approach Textbook” for Graduate Examination of the Seventeenth Century. Headache 2015; 55:576-7. [DOI: 10.1111/head.12548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ferdinando Maggioni
- Headache Centre; Department of Neurology; School of Medicine; University of Padua; Padua Italy
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Abstract
Migraine is a disabling neurological condition manifesting with attacks of headache, hypersensitivities to visual, auditory, olfactory and somatosensory stimuli, nausea, and vomiting. Exposure to sensory stimuli, such as odours, visual stimuli, and sounds, commonly triggers migraine attacks, and hypersensitivities to sensory stimuli are prominent during migraine attacks, but can persist with less magnitude between attacks. Functional MRI (fMRI) has been used to investigate the mechanisms that lead to migraine sensory hypersensitivities by measuring brain responses to visual, olfactory, and painful cutaneous stimulation, and functional connectivity analyses have investigated the functional organisation of specific brain regions and networks responsible for sensory processing. These studies have consistently shown atypical brain responses to sensory stimuli, absence of the normal habituating response between attacks, and atypical functional connectivity of sensory processing regions. Identification of the mechanisms that lead to migraine sensory hypersensitivities and that trigger migraine attacks in response to sensory stimuli might help to better understand neural dysfunction in migraine and provide new targets for migraine prevention, and could provide fMRI biomarkers that indicate early responses to preventive therapy.
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Tyler RS, Pienkowski M, Roncancio ER, Jun HJ, Brozoski T, Dauman N, Coelho CB, Andersson G, Keiner AJ, Cacace AT, Martin N, Moore BCJ. A review of hyperacusis and future directions: part I. Definitions and manifestations. Am J Audiol 2014; 23:402-19. [PMID: 25104073 DOI: 10.1044/2014_aja-14-0010] [Citation(s) in RCA: 177] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Hyperacusis can be extremely debilitating, and at present, there is no cure. We provide an overview of the field, and possible related areas, in the hope of facilitating future research. METHOD We review and reference literature on hyperacusis and related areas. We have divided the review into 2 articles. In Part I, we discuss definitions, epidemiology, different etiologies and subgroups, and how hyperacusis affects people. In Part II, we review measurements, models, mechanisms, and treatments, and we finish with some suggestions for further research. RESULTS Hyperacusis encompasses a wide range of reactions to sound, which can be grouped into the categories of excessive loudness, annoyance, fear, and pain. Many different causes have been proposed, and it will be important to appreciate and quantify different subgroups. Reasonable approaches to assessing the different forms of hyperacusis are emerging, including psychoacoustical measures, questionnaires, and brain imaging. CONCLUSIONS Hyperacusis can make life difficult for many, forcing sufferers to dramatically alter their work and social habits. We believe this is an opportune time to explore approaches to better understand and treat hyperacusis.
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Affiliation(s)
| | | | | | | | - Tom Brozoski
- Southern Illinois University School of Medicine, Springfield
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Jürgens TP, Berger K, Straube A, Khil L. Migraine with aura is associated with impaired colour vision: Results from the cross-sectional German DMKG headache study. Cephalalgia 2014; 35:508-15. [PMID: 25179294 DOI: 10.1177/0333102414547136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/13/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hypersensitivity to light, noise and odour are pivotal clinical characteristics of migraine associated with enhanced cortical excitability and dysfunctional habituation. However, little is known about the integrity of basic sensory functioning in migraine on a population-based level. METHODS A total of 129 participants with migraine (105 without aura, MwoA, 24 with aura, MA) and 522 healthy controls without headache 12 months prior to baseline were included from a sample of the DMKG study and underwent standardised clinical sensory testing of smell, taste, hearing and vision. RESULTS After adjustment for age, sex, smoking status and history of head injuries, the chance of impaired colour perception was significantly higher in MA compared to controls (odds ratio, OR=3.20; 95% CI=1.20-8.53) and MwoA (OR=3.62; 95% CI=1.31-9.97). Compared to MwoA, MA also had an increased chance of smell (OR=3.20; 95% CI=0.98-10.42) and taste (OR=2.58; 95% CI=0.90-7.40) impairment. CONCLUSIONS In this cross-sectional, population-based study on sensory functioning in migraine participants, colour vision was impaired interictally in MA compared to MwoA and controls.
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Affiliation(s)
- T P Jürgens
- Department of Systems Neuroscience, University Medical Centre Hamburg-Eppendorf, Germany
| | - K Berger
- Institute of Epidemiology and Social Medicine, Westfälische Wilhelms-University Münster, Germany
| | - A Straube
- Department of Neurology, Ludwig-Maximilians University, Germany
| | - L Khil
- Institute of Epidemiology and Social Medicine, Westfälische Wilhelms-University Münster, Germany
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Baldacci F, Lucchesi C, Ulivi M, Cafalli M, Vedovello M, Vergallo A, Prete ED, Nuti A, Bonuccelli U, Gori S. Clinical features associated with ictal osmophobia in migraine. Neurol Sci 2014; 36:43-6. [PMID: 25070382 DOI: 10.1007/s10072-014-1903-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 07/18/2014] [Indexed: 01/25/2023]
Abstract
Olfactory hypersensitivity may occur during migraine attacks and has been found to be very specific for this form of headache. Aim of this study was to investigate if migraineurs with ictal osmophobia have particular clinical features comparing to patients without ictal osmophobia. We recruited 200 consecutive migraineurs. Other primary headaches comorbidity and migraine prophylaxis were exclusion criteria. Each patient was interviewed following a structured questionnaire including general features about migraine, depression and anxiety symptoms. Migraine triggers both spontaneously and selecting from a specific list. Allodynia during the migraine attack was measured using the Allodynia symptoms check-list 12 (ASC-12). Eighty four (42 %) patients are non-osmophobic vs. 116 patients (58 %) who are osmophobic. After a logistic regression analysis, pain intensity (OR 1.391; p = 0.008) and anxiety (OR 1.099; p = 0.047) were significantly higher while aura (OR 0.421; p = 0.028) is less frequent in osmophobic migraineurs. We found significant differences in clinical features of osmophobic patients in respect to non-osmophobic ones. Ictal osmophobia seems being related to a broader sensorial hypersensitivity that could lead to a more florid clinical presentation.
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Affiliation(s)
- Filippo Baldacci
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa, Italy
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Correlations between brain cortical thickness and cutaneous pain thresholds are atypical in adults with migraine. PLoS One 2014; 9:e99791. [PMID: 24932546 PMCID: PMC4059715 DOI: 10.1371/journal.pone.0099791] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 05/18/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND/OBJECTIVE Migraineurs have atypical pain processing, increased expectations for pain, and hypervigilance for pain. Recent studies identified correlations between brain structure and pain sensation in healthy adults. The objective of this study was to compare cortical thickness-to-pain threshold correlations in migraineurs to healthy controls. We hypothesized that migraineurs would have aberrant relationships between the anatomical neurocorrelates of pain processing and pain thresholds. METHODS Pain thresholds to cutaneously applied heat were determined for 31 adult migraineurs and 32 healthy controls. Cortical thickness was determined from magnetic resonance imaging T1-weighted sequences. Regional cortical thickness-to-pain threshold correlations were determined for migraineurs and controls separately using a general linear model whole brain vertex-wise analysis. A pain threshold-by-group interaction analysis was then conducted to estimate regions where migraineurs show alterations in the pain threshold-to-cortical thickness correlations relative to healthy controls. RESULTS Controls had negative correlations (p<0.01 uncorrected) between pain thresholds and cortical thickness in left posterior cingulate/precuneus, right superior temporal, right inferior parietal, and left inferior temporal regions, and a negative correlation (p<0.01 Monte Carlo corrected) with a left superior temporal/inferior parietal region. Migraineurs had positive correlations (p<0.01 uncorrected) between pain thresholds and cortical thickness in left superior temporal/inferior parietal, right precuneus, right superior temporal/inferior parietal, and left inferior parietal regions. Cortical thickness-to-pain threshold correlations differed between migraine and control groups (p<0.01 uncorrected) for right superior temporal/inferior parietal, right precentral, left posterior cingulate/precuneus, and right inferior parietal regions and (p<0.01 Monte Carlo corrected) for a left superior temporal/inferior parietal region. CONCLUSIONS Unlike healthy control subjects who have a significant negative correlation between cortical thickness in a superior temporal/inferior parietal region with pain thresholds, migraineurs have a non-significant positive correlation between cortical thickness in a superior temporal/inferior parietal region with pain thresholds. Since this region participates in orienting and attention to painful stimuli, absence of the normal correlation might represent a migraineurs inability to inhibit pain sensation via shifting attention away from the painful stimulus.
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Silva-Néto RP, Peres MFP, Valença MM. Accuracy of osmophobia in the differential diagnosis between migraine and tension-type headache. J Neurol Sci 2014; 339:118-22. [DOI: 10.1016/j.jns.2014.01.040] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/10/2014] [Accepted: 01/29/2014] [Indexed: 11/15/2022]
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Marmura MJ, Monteith TS, Anjum W, Doty RL, Hegarty SE, Keith SW. Olfactory function in migraine both during and between attacks. Cephalalgia 2014; 34:977-85. [PMID: 24646836 DOI: 10.1177/0333102414527014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION People with migraine often report being osmophobic, both during and between acute migraine attacks. It is not clear, however, whether such reports are associated with changes in olfaction such as hyperosmia, as measured by psychophysical testing. In this case-control study we quantitatively assessed olfactory identification ability, which correlates with threshold tests of olfactory acuity, in patients with migraine at baseline (no headache), during migraine episodes, and after a treated attack and compared the test scores to those of matched control subjects. METHODS Fifty episodic migraine subjects and 50 and sex- and age-matched controls without headache were tested. All completed the University of Pennsylvania Smell Identification Test (UPSIT), a standardized and well-validated olfactory test. RESULTS At baseline, the UPSIT scores did not differ significantly between the migraine and control study groups (median paired score difference: -1, p = 0.18). During migraine attacks, a minority of migraine subjects (eight of 42) developed microsmia (i.e. lower test scores by at least four points), suggesting that, as compared to their matched controls, olfactory acuity was somewhat impaired during migraine attacks (p = 0.02). This difference was less pronounced and not statistically significant after a successfully treated attack (p = 0.15). DISCUSSION People with episodic migraine were found to have similar olfactory function as age- and sex-matched controls, but a minority exhibit microsmia or hyposmia during acute attacks. The cause of this dysfunction is unknown, but could relate to autonomic symptoms, limbic system activation, or disorders of higher order sensory processing.
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Affiliation(s)
- Michael J Marmura
- Department of Neurology, Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Waseem Anjum
- Department of Neurology, Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Richard L Doty
- Smell & Taste Center, Department of Otorhinolaryngology, Perelman School of Medicine, University of Pennsylvania, PA, USA
| | - Sarah E Hegarty
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Scott W Keith
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
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