Headache Medicine, v.3, n.3, p.101, Jul./Aug./Sep. 2012 101

Osmophobia and headache triggered by odors in patients

with migraine and tension-type headache (abstract)

Osmofobia e odor como fator deflagrador de cefaleia em pacientes com migrânea

e cefaleia do tipo tensional (resumo)

Migraine is manifested by recurrent episodes of

headache and associated symptoms, including nausea,

vomiting, photophobia and phonophobia. Besides these,

there may osmophobia, an intolerance to odors associated

with primary headaches, especially with migraine, both in

crisis as the period between episodes.

Objectives:Objectives:

Objectives: To characterize odorants with those that

trigger migraine attacks and to evaluate accuracy of

osmophobia in the diagnosis of migraine.

atients and Methods:atients and Methods:

atients and Methods: This was a cross-sectional study

examining non-random sample of convenience, in period from

August to December 2011. There were 400 patients, 200 with

migraine and 200 with tension-type headache according to

diagnostic criteria of International Classification of Headache

Disorders - second edition. Through a questionnaire, were

interviewed about odorants triggers of headache, time of onset

of pain after exposure and osmophobia during crisis and period

between episodes. Odorants were divided into eight categories:

foul odors, perfumes, oil, insecticides, cleaning products,

cooking and beauty and others.

Results:Results:

Results: Of the 400 respondents, 219 (54.8%) were

female and 181 (45.2%) male. The age ranged from 22 to 58

years (38.6 ± 0.5 years, 95%CI 37.6 to 39.6). Of the 200

patients with migraine, 182 (91.0%) were female and 18 (9.0%)

male and 200 patients with tension-type headache, 37 (18.5%)

were female and 163 (81.5% of) male. The ratio male/female

for migraine and tension-type headache was equal,

respectively, to 0.1:1 and 4.4:1.0. The age of patients with

migraine and tension-type headache was, respectively, 37.3

± 0.6 (95%CI 36.0 to 38.6) and 40.0 ± 0.7 (95%CI 38.5 to

41.4) years. The differences for sex (p<0.001, χ

) and age

(p = 0.008, Mann-Whitney test) were significant. There was

triggered of headache by odors after 25.5 ± 1.9 minutes and

median of 20 minutes of exposure in 70.0% (140/200) of

patients with migraine and none with tension-type headache,

Raimundo Pereira Silva-Néto

Universidade Federal de Pernambuco. Pós-graduação de Neuropsiquiatria e Ciências do Comportamento

(área de concentração: Neurologia). MSc Thesis. 2012. Orientador: Marcelo Moraes Valença

Silva-Néto RP. Osmophobia and headache triggered by odors in patients with migraine and

tension-type headache (abstract). Headache Medicine. 2012;3(3):101

THESESTHESES

THESES

which ran the low sensitivity (70.0%, 95%CI=63.1 to 76.2)

and high specificity (100.0%, 95%CI=97.6 to 100.0). Odors

triggers headache are distributed in that order of frequency:

perfumes (106/140, 75.7%), paints (59/140, 42.1%), gasoline

(40/140, 28.6%) and bleach (38/140, 27.1%). There was

significant in the association of odors trigger migraine,

especially among perfume with cleaning (Phi=-0.459),

cooking (Phi=0.238), beauty (Phi=-0.213) and foul odors

(Phi=-0.582). During the crisis, osmophobia occurred in

86.0% (172/200) of patients with migraine and 6.0% (12/

200) of those with tension-type headache. In migraine,

osmophobia was associated with photophobia and

phonophobia (66/200, 33.0%) or with nausea, photophobia

and phonophobia (107/200, 53.5%) and presented high

sensitivity (86.0%, 95%CI=80.2 to 90.3) and specificity (94.0%,

95%CI=89.5 to 96.7), with low percentages of false positives

(6.5%, 95%CI=3.6 to 11.4) and negatives (13.0%,

95%CI=8.9 to 18.4). In the period between episodes,

osmophobia was restricted to migraine patients (48/200,

24.0%). The areas under ROC curves were: 0.903 ± 0.017

to osmophobia during crisis; 0.784 ± 0.025 between crisis;

0.807 ± 0.023 to photophobia/phonophobia, and 0.885 ±

0.017 to pain developed by odors.

Conclusions:Conclusions:

Conclusions: Odorants triggered migraine attacks in

that order of frequency: perfumes, paints, gasoline and bleach.

Osmophobia predominated in patients with migraine and may

be a specific marker to differentiate migraine of tension-type

headache.

Correspondence

aimundo Paimundo P

aimundo P

. Silva-Néto. Silva-Néto

. Silva-Néto

E-mail: neurocefaleia@terra.com.br