Headache Medicine 2021, 12(2) p-ISSN 2178-7468, e-ISSN 2763-6178
Headache Medicine
© Copyright 2021
DOI: 10.48208/HeadacheMed.2021.19
Is it possible to sort the disability of individuals with migraine
based on the International Classication of Functioning, Disability
and Health? A Scoping Review
Hugo Feitosa , Débora Wanderley , Manuella Morais Monteiro Barbosa Barros , Suellen Freitas da Silva ,
Alyne Karine de Lima Santos , Angélica da Silva Tenório , Daniella Araújo de Oliveira
Universidade Federal de Pernambuco, Recife, Brazil.
To identify the most frequent outcomes related to disability assessed in individuals with mi-
graine and to correlate these ndings with the categories of International Classication of
Functioning, Disability and Health.
Material and method
This scoping review was developed based on studies with adult population (18-55 years)
of both sexes and assessing the disability generated by migraine. We included studies in
which patients had a diagnosis of migraine based on International Classication of Hea-
dache Disorders.
52 articles were found with 42 outcomes related to 17 categories of International Classi-
cation of Functioning, Disability and Health, including the four main components of the
classication, with seven categories in "Body Functions", one in "Body Structures", four in
Activities and Participation” and ve in "Environmental Factors".
The ndings show that disabilities, activity limitation, or participation restriction generated
by migraine can be classied by International Classication of Functioning, Disability and
Health. The components "body functions", "environmental factors" and "activities and par-
ticipation" were the most identied in the present study. Thus, this classication is important
to classify the disability caused by migraine and to guide a rehabilitation more focused on
the patient's real demands, as well as directing the research involving this population.
Hugo Gabriel Feitosa de Souza,
Department of Physical Therapy,
Federal University of Pernambuco,
Av. Jorn. Aníbal Fernandes,173 –
Cidade Universitária, Zip Code:
50740-560, Recife –PE.
Phone: + 55 (81) 2126.8937.
E-mail: hugogfeitosa@gmail.com
Edited by:
Marcelo Moraes Valença
International Classification of Func-
Disability and Health
Sickness Impact Prole
Environmental Health
Migraine disorders
Disabled Persons
Received: September 30, 2021
Accepted: October 5, 2021
Feitosa H, Wanderley D, Barros MMMB, Silva SF, Santos AKL, Tenório AS, Oliveira DA
Is it possible to sort the disability of individuals with migraine based on the International Classication of Functioning, Disability and Health? — A Scoping Review
igraine is the third-most prevalent disease in the world
and the second one to cause larger numbers of lost
work days due to a disability.
Sleep disorders, decrease in
the perception of quality of life and the well-being sensation
and increase in anxiety crises have been related to migraine
crises, in addition to the inuence in social function due
to disability and decreasing social status caused by this
In this way, there are severe impacts of migraine on the
quality of life and social function of the affected individuals,
which makes this illness affect a wider spectrum as it
generates psychological and social problems for both the
affected individual and the social environment to which he
belongs to either for the greater difculty in maintaining
social relations or even for the economic impacts caused
by the reduced productivity of migraineurs.
Because migraine is a disease that causes negative
impacts that go beyond biomedical issues, the World
Health Organization (WHO) instituted the International
Classication of Functioning, Disability and Health (ICF),
whose classication model seeks to obtain a broader
view of the health-disease process. Thus, it is important
to assess migrants in a broader perspective that covers
physical, emotional, psychological, functional, social and
environmental conditions.
Despite the exposed, there is a gap in literature about
biopsychological issues generated by migraine that have
undeniable implications on the patients’ functioning.
Therefore, the application of ICF is a way to classify the
functioning of this population, since this proposal focuses
on the patients approach on this broader vision as
adopted by the WHO.
Therefore, the present study aimed to conduct as coping
review to map the most important implications of migraine in
a patients functioning from the main disabilities presented
by this population in the past studies.
Material and Methods
It’s a scoping review recorded on Open Science Framework.
In as coping review, the methodology seeks to map
the determined subject through a systematized starting
point, including summarization and analytical review of
published texts.
As coping review proposal is to search
for information regarding the selected process, which
frequently demands that diverse outcomes be used. Thus,
such review can act as a tool for conducting systematic
reviews as suggested by past data.
The standard model,
as proposed by Joanna Briggs Institute Manual, suggests
the following: 1. Creation of title, aim, and conductor
question to be answered;2. Choice of sources and search
for data chain are followed by study selection and data
extraction; and 3. Presentation of results and practical
It is important to highlight that, in the study selection, as
proposed by the Joanna Briggs Institute guide, inclusion and
exclusion criteria were applied, based on the population,
context, and concept, with the aim of responding to the
conductor question of “what are the disabilities related to
adult patients with migraine?”
Inclusion Criteria
Adults (18–55 years) of both the sexes were included
in this review, considering that migraine affects different
age groups and also this age group represents the higher
prevalence range.
Disability has been the searched concept dened by WHO
as a term that includes deciencies (related to functions
and structures), limitations (joined to performed) activities,
and restrictions (related to social participation) as well as
environmental factors interacting with these constructs.
Studies that assessed patients with a prior diagnosis
of migraine were included, as per the International
Classication of Headache Disorders (ICHD) Versions I
, III-Beta
, with the objective of broadening the impact
spectrum of migraine patients included in hospitals,
outpatient clinics, specialized centers for headaches, or in
their own communities.
Study Selection
The searches were conducted from November 2017
to June 2018 and updated on June 2020, by a trained
personal in the following databases: Medine/Pubmed,
Feitosa H, Wanderley D, Barros MMMB, Silva SF, Santos AKL, Tenório AS, Oliveira DA
Is it possible to sort the disability of individuals with migraine based on the International Classication of Functioning, Disability and Health? — A Scoping Review
Lilacs, Cinahl, Scopus (Elsevier) Web of Science, and
Cochrane Database of Systematic Reviews, by using
indexed descriptors and keywords, without restriction of
year of publication, language or study design.
Research Strategies
In the databases Medline, Scopus (Elsevier) Web of
Science, and Cochrane Database of Systematic Reviews,
we considered the following descriptors of the Medical
Subject Headings (MeSH): “Migraine Disorders,
“Disability Evaluation, “Quality of Life, and the keyword
“Functioning. For a Lilacs basis, we considered the
descriptors in Health Sciences (Migraine Disorders),
Quality of Life, Disability Assessment, and a keyword
“Functioning. From the database Cinahl, we used the terms
of its titles: “Migraine, “Disability Assessment, “Quality of
life, “International Classication of Functioning“Disability
AND Health” AND “Functioning.
The Boolean operator AND” was used to cross the descriptors
by dening the search strategy (Figure 1).
Primary Identification of the Articles
Initially, the studies shortlisted from the search strategies
were identied by title and abstract and summarized so
that two independent researchers could judge whether they
were relevant to answer the conducting question. In case
of a disagreement, a third researcher would be activated
to assist in clarifying doubts and taking a nal decision
about the relevance of the article. In cases where, even
after taking these measures, the article relevance was still
considered dubious, it would be included for the reading
phase of the full text for deeper clarication. Next, those
articles that met the inclusion criteria and could adequately
answer the guiding question were nally included in the
Data Extraction
For this phase, a spreadsheet was created in the Microsoft
Excel Program to be lled with each study data. The ones
collected from each study included: article title, authors
names, publication date, diagnostic criteria, population’s
age range, main study outcomes, and tools used for this
We then organized a table with these data by relating the
outcomes found with the equivalent ICF categories in the
sense of identifying the ones that were more relevant for the
assessment of patients with migraine.
Figure 2 shows the capitation owchart of articles in this
review. In the initial search, 2,567 articles were found, of
which 979 were repeated between databases, 889 were
excluded after reading their titles or abstracts, and 698
articles were considered relevant for reading the text.
After the complete reading of the articles, 584 of them
were excluded because they did not meet the inclusion
criteria or for being considered irrelevant for the study.
With this proceeding only 114 were taken to the phase of
data extraction. In these 114 articles, we have identied
that 60 studies used exclusively the result of validated
questionnaires for patients with migraine: Migraine
Disability Assessment (MIDAS), Headache Impact Test-6
(HIT-6) e Migraine-Specic Quality of Life Questionnaire
(MSQ). For recognizing the importance of such
questionnaires in the assessment of patients with migraine,
these studies were considered relevant and included in
this review. However, at the moment of data extraction, it
was not possible to identify what functional aspects of the
patients were affected, since the presentation of results of
these studies did not permit to identify which categories
were more relevant in this population. Because of this,
just the 52 remaining articles had their data extracted,
tabulated and categorized in our study.
Description of Articles
The 54 articles included in this review were published in
17 different countries, involving 13,383 patients, with a
mean age of 38.7 years, of whom 9,621 were women,
3,762 men and 2,264 were not identied in relation to sex
in the studies. As for the publishing location, it is possible
to highlight the United States as the place with larger
number of publications. These studies were published in
the interview from 1994 up to 2019, being 2012 the year
that presented the largest number of publications of the
articles included in this research (Table 1).
The study design most found in this study was randomized
clinical trial (23 articles), followed by cross-sectional studies
(13 articles), literature reviews, and then other types of
study (such as cohort, systematic review, control-case, and
qualitative), totaling 9 articles.
Table 2 shows the outcomes found in this scoping review
and the ICF-correlated categories. The assessed outcomes
in these articles were related to 17 ICF categories, of which
seven were for the components “Body Functions, one for
Feitosa H, Wanderley D, Barros MMMB, Silva SF, Santos AKL, Tenório AS, Oliveira DA
Is it possible to sort the disability of individuals with migraine based on the International Classication of Functioning, Disability and Health? — A Scoping Review
#1 ("Migraine Disorders"[Mesh]) AND ("Disability Evaluation"[Mesh])
#2 ("Migraine Disorders"[Mesh]) AND ("Quality of Life"[ Mesh])
#3 ("Migraine Disorders"[Mesh]) AND (“Functioning”)
#4 ("Migraine Disorders"[Mesh]) AND "Cost of Illness"[Mesh]
Web of Science
#1 ("Migraine Disorders") AND ("Quality of Life")
#2 ("Migraine Disorders"[Mesh]) AND ("Disability Evaluation"[Mesh])
#3 ("Migraine Disorders"[Mesh]) AND (“Functioning”)
#1 (“Transtornos de Enxaqueca” [DeCS]) AND (“Avaliação de deciência” [DeCS])
#2 (“Transtornos de Enxaqueca” [DeCS]) AND (“Qualidade de Vida” [DeCS])
#3 (“Transtornos de Enxaqueca” [DeCS]) AND (“Qualidade de Vida”) AND (Avaliação de
deciência” [DeCS])
#4 (“Transtornos de enxaqueca”) AND (“Funcionalidade)
#1 (“Migraine”) AND ("Disability Evaluation")
#2 (“Migraine”) AND ("Quality of Life")
#3 ("Migraine") AND ("International Classication of Functioning, Disability and Health”)
#4 ("Migraine) AND (“Functioning”)
#1 ("Migraine Disorders"[Mesh]) AND ("Quality of Life"[ Mesh])
#2 ("Migraine Disorders"[Mesh]) AND ("Disability Evaluation"[ Mesh])
#1 ("Migraine Disorders"[Mesh]) AND ("Disability Evaluation"[Mesh])
#2 ("Migraine Disorders"[Mesh]) AND ("Quality of life"[Mesh])
#3 ("Migraine Disorders") AND (“Functioning”)
Figure 1. Search strategies for MEDLINE/ Pubmed, Lilacs, Cinahl, Cochrane Database of Systematic Reviews and Scopus (Elsvier) databases.
Feitosa H, Wanderley D, Barros MMMB, Silva SF, Santos AKL, Tenório AS, Oliveira DA
Is it possible to sort the disability of individuals with migraine based on the International Classication of Functioning, Disability and Health? — A Scoping Review
Figure 2. Preferred Reporting Items for Systematic Reviews and Meta-Analyses ow diagram of included articles.
Feitosa H, Wanderley D, Barros MMMB, Silva SF, Santos AKL, Tenório AS, Oliveira DA
Is it possible to sort the disability of individuals with migraine based on the International Classication of Functioning, Disability and Health? — A Scoping Review
Table 1. Characteristics of studies included in the scoping review (n =54).
Period Country Study Design n Period Country Study Design n
2001-2004 Brazil Cross-sectional study 2
Cross-sectional study 1 USA Literature review 1
China Systematic review 1 Case-control study 1
Philippines Cross-sectional study 1 Cross-sectional study 1
Brazil Cross-sectional study 2 Longitudinal study 1
Iran RCT 1 France RCT 1
USA Literature review 1 Turkey RCT 1
RCT 2 Germany RCT 1
Spain Systematic review 1 1997-2000 USA RCT 1
Netherlands RCT 1 Literature review 1
2009-2012 USA RCT 6 France Cohort study 2
Brazil RCT 1 England Cross-sectional study 1
Thailand RCT 1 1994-1996 USA RCT 1
Taiwan Cross-sectional study 1 Netherlands Cross-sectional study 1
Switzerland Observational study 1 USA RCT 1
China RCT 1 India RCT 1
Iran Case-control study 1
2005-2008 USA RCT 2
Case series study 2
Observational study 1
Literature review 1
Qualitative study 1
Norway Literature review 1
Taiwan Cross-sectional study 1
France RCT 1
Note. RCT: Randomized Clinical Trial
Feitosa H, Wanderley D, Barros MMMB, Silva SF, Santos AKL, Tenório AS, Oliveira DA
Is it possible to sort the disability of individuals with migraine based on the International Classication of Functioning, Disability and Health? — A Scoping Review
Table 2. Outcomes evaluated in studies included, related to International Classication of Functioning, Disability and Health categories and its
description (n =42).
Outcomes Found/ Tools Related Category Description
Body functions
Frequency of pain, intensity of pain/ Headache diary,
Visual analogue Scale
b280 Sensation of pain
Sensation of unpleasant feeling indicating potential or actual damage to
some body structure.
Energy and vitality/ SF-36 b130 Energy and drive functions
General mental functions of physiological and psychological mechanisms
that cause the individual to move towards satisfy specic needs and
general goals in a persistent manner.
Exercise tolerance, physical activity tolerance, worsens
with physical activity, aggravation with physical
activity, physical performance, vigorous activity/,
qualitative interview, anamnesis, Fatigue Severity
b4559 Exercise tolerance functions,
Nausea and vomiting/ qualitative interview, free
b5106 Functions of expelling the
contents of the stomach, oesophagus
or pharynx
Functions of moving substances such as food, liquid, medications, objects
intentionally or unintentionally swallowed in the reverse direction to
ingestion, such as in regurgitation and vomiting.
sleepiness, sleep disturbances, to sleep, ability to
sleep/ qualitative interview, Epworth Sleepiness
Scale, Subjective sleep quality was assessed using the
Pittsburgh Sleep Quality Index
b134 Sleep functions
General mental functions of periodic, reversible and selective physical and
mental disengagement from one's immediate environment accompanied by
characteristic physiological changes.
Stress, mood, impact on mood, irritability/
Generalized Anxiety Disorder 7-item scale, Patient
Health Questionnaire 9-item Scale
b1263 Psychic stability
Mental functions that produce a personal disposition that is even-tempered,
calm and composed, as contrasted to being irritable, worried, erratic and
Memory/ Fear conditioning test, qualitative interview b144 Memory functions
Specic mental functions of registering and storing information and
retrieving it as needed.
Body structures
Head and neck/ Cervical Range of Motion,
algometry, Neck disability index
s710 Structure of head and neck
Activities and participation
Workdays lost, ability to work, work score, work
performance/ free questions, qualitative interview,
American Migraine Prevalence and Prevention, Years
lived with disability
d850 Remunerative employment
Engaging in all aspects of work, as an occupation, trade, profession or
other form of employment, for payment, as an employee, full or part time,
or self-employed, such as seeking employment and getting a job, doing the
required tasks of the job, attending work on time as required, supervising
other workers or being supervised, and performing required tasks alone
or in groups.
Leisure and recreation activities d920 Recreation and leisure Engaging in any form of play, recreational or leisure.
Social function, social activity, social interactions,
social isolation.
d9205 Socializing
Engaging in informal or casual gatherings with others, such as visiting
friends or relatives or meeting informally in public places.
To walk, ability to walk/ qualitative interview,
anamnesis, Fatigue Severity Scale
d450 Walking
Moving along a surface on foot, step by step, so that one foot is always
on the ground, such as when strolling, sauntering, walking forwards,
backwards, or sideways.
Environmental factors
School performance, intellectual performance, school
score, schooldays lost
e5850 Education and training
Services and programmes concerned with education and the acquisition,
maintenance and improvement of knowledge, expertise and vocational or
artistic skills, such as those provided for different levels of education
Light, strong lights and photophobia/ Headache diary,
e240 Light
Electromagnetic radiation by which things are made visible by either
sunlight or articial lighting
Sound, noise and phonophobia/ Headache diary,
e2500 Sound intensity
Level or volume of auditory phenomenon determined by the amount of
energy being generated, where high energy levels are perceived as loud
sounds and low energy levels as soft sounds.
Note. b: Body functions; s: Body structures; d: Domains; e: Environment
Feitosa H, Wanderley D, Barros MMMB, Silva SF, Santos AKL, Tenório AS, Oliveira DA
Is it possible to sort the disability of individuals with migraine based on the International Classication of Functioning, Disability and Health? — A Scoping Review
“Body Structures, four for Activities and participation,
and ve for “Environmental Factors.
In the 60 articles that used some validated questionnaire,
but did not present results that could answer this review
question, totaled a population of 19,153 people, of which
15,703 were women and 3,273 men with ages 18–55
years (average age: 38.6 years).
The disability classication of patients with migraine can
be performed through the ICF, but it is still an uncommonly
used instrument in studies developed in this thematic.
The validating tools for assessing the migraine impact
are unclear in their results about the aspects of life that
are more affected, besides being not able to address
satisfactorily the biopsychosocial aspects, the factors that
makes it imperative to majorly use the ICF in the disability
classication of patients with migraine.
Studies about the functioning of patients with migraine
are not a recent phenomenon. This review found articles
dated from the year 1994. In addition, there exists several
validated instruments to assess the disability measures
and migraine impact in several aspects of a patients
life. Nevertheless, it was detected that identication was
difcult from the study’s results regarding the aspects of a
patient’s life that were more affected.
Body Functions
In this component, it was found that the most-prevalent
category of the studies of this scoping review was “b280
pain sensation, which conrms the presently known
information about migraine, by considering pain as the
main characteristic.
It is therefore important to highlight,
however, that migraine has, more and more, presented
itself as a process not limited to pain sensation only.
Corroborating this observation, other ndings of this
review claries that factors joined to body functions show
alteration in migraineur’s population.
Despite this, the importance of this category is not
diminished since the pain frequency remains the most
important outcome in the assessment of this population for
altering the life quality signicantly and collaborating with
other following outcomes.
Furthermore, it was possible
to conrm, in the present review, that the most-assessed
outcomes in the studies of migraineurs’ populations were
related to pain sensation in the patient.
In “body functions, the second-most frequent category was
“b 130 Functions of energy and impulses” that included
issues such as motivation, appetite, desire, and impulse
There is a past study that demonstrated the
relation between migraine and the functions of energy as
well as the impulses when they demonstrate the thalamus
involvement in the alterations caused by migraine in
functions of food intake and anxiety control.
Furthermore, the outcome called vitality was included in this
category. Thus, the number of articles that used the Medical
Outcomes Short-Form Health Survey (SF-36), despite
the existence of specic and validated questionnaires,
increases the number of researchers that assessed this item.
However, the patients’ perception and the neuropathogenic
explanation of migraine itself demonstrates that this
category has relevance for a studied population, which
makes its presence imperative in instruments that seek to
assess or classify this population.
In 17% of the articles included in this review, the outcomes
related to the category “b5106 Regurgitation and
Vomiting” were found. It is therefore important to detach
that, in relation to qualitative studies, this category has
been constantly indicated by patients, which leads us
to believe that its impact in migraineursquality of lives
remains underestimated by the studies now conducted with
this population.
Within the component Body Functions, is remains
important to highlight that 15.6% of the included articles
assessed the outcomes related to tolerance to physical
exercise or to sleep functions. Concerning physical
exercises, the established relation in larger part of the
studies found, reference to this issue of crises aggravation
with the performance of physical exercises.
it was not related to the cardiovascular system, as would
be in the ICF category present in this component. Instead,
some existing studies are researching beyond this question
and have shown that, despite this established fact, the
performance of physical exercises between the periods of
crises have shown efcacy in the reduction of frequency
and in the intensity of crises in patients with migraine.
Therefore, it is important to further evaluate this point in
order to clarify what intensity of migraine diminishes the
tolerance to exercise with a differentiation of the periods
without and with crises.
Regarding sleep functions, a previous study
improvement in the sleep quality among treated patients
with migraine, while another one
established an
important relationship among patients who presented
Feitosa H, Wanderley D, Barros MMMB, Silva SF, Santos AKL, Tenório AS, Oliveira DA
Is it possible to sort the disability of individuals with migraine based on the International Classication of Functioning, Disability and Health? — A Scoping Review
migraine and reduction in the sleep quality and the risk of
sleep apnea. This nding showed that, despite it not being
possible to establish a relationship between the cause and
effect, it has already been demonstrated that reduction in
the sleep quality is twice as much prevalent in population
with migraine as in the general population, which makes it
important to detach that this is a prevalent condition in the
classication of patients with migraine, both by established
relation and by the impact that sleep quality has on quality
of life of these patients.
Body Structures
The outcomes to body structures found were inserted in
the rank “s710 Structure of the region of the head and
of the neck. It is therefore important to highlight that the
included studies presented measurements that were more
related to the region of the neck than to that of the head,
despite the fact that a migraine is actually a headache.
This phenomenon can be explained by the fact that
migraine’s impact on the head region is very established,
while investigations are on about its impact on the neck
A previous study assessed the shoulder region, and
some other studies studied the connection of migraine
and structures of the vertebral column and the impact of
other body regions via peripheral sensitization. However,
the small number of researches that have assessed these
outcomes have shown that the major focus of research
remains restricted to the region where the pain occurs.
The allodynia questionnaire is a device that extrapolates
this more local logic of assessment of patients with migraine
and seeks, albeit in a generic way, to identify repercussions
in other body regions. However, in this study, none of the
included studies used this tool, which could have enlarged
the number of categories listed in this component.
Activities and participation
Activities and participation” is one of the greatest legacies
that the ICF brings to this population classication. The
functioning and disability generated by this sickness are
exactly related to the individual capacity of using a body
(structures and functions) in contact with a determined
environment to execute tasks (activities) inserted in a
specic social context.
This scoping review identied a
large number of outcomes related to this component, which
corroborated with the status of up-to-date art, in that this
is a disabling disease with a high personal and social
The highest frequency among these categories
was “d850 paid work.” The economic aspect linked to this
category enhances its importance, which explains it being
the most frequent aspect in this component. It was also
necessary to detach that this population prole strengthens
this impact, since the major prevalence of the disease
happens exactly, within the age group economically
A paper on Brazilian population estimated that >55% of
its population with migraine works in Brazil, while ≥10%
are unemployed and 20% are “housewives” or “students,
so that almost 85% of the study population can be deemed
to be potentially active.
In addition, absenteeism and decrease in productivity of
people during migraine crises generate costs or income
decit both for themselves and for the market they are
based in, what makes that, especially at this point, migraine
becomes a disease of great impact, both at personal and
social fronts. As a result, migraine can be considered as a
public health problem.
The second-most frequent category was “socializing. Here
are included denouements related to social functions and
socialization. Despite being generic, the idea they send to,
shows the impact caused by migraine in the social life.
Then, it becomes important to highlight that researchers
should give greater attention to this rank and this should
be further investigated to obtain more specic outcomes in
the context of socialization of the population with migraine.
Nevertheless, it was also possible to perceive the relation
between migraine and the outcomes linked to the rank
activities of recreation and leisure,” which revealed that
restriction in these activities directly affects the quality of
life of individuals with migraine.
Thus, it has become imperative that patients’ assessment
not only about this ailment has clinical repercussions,
the professionals who take care of this population need
to pay special attention to social factors affecting these
individuals in the sense of understanding which aspects
of their social life needs improvement as well as rethink
the existing therapeutics to promote entanglement among
clinical objectives and patient’s demands.
Environmental Factors
As consolidated previously in the literature, the inuence of
environmental factors, especially those concerning crises
triggers in individuals with migraine. In this scope, the most
frequently found outcomes in the articles included “e240
Light” and e2500 Sound Intensity”. Both of these papers
Feitosa H, Wanderley D, Barros MMMB, Silva SF, Santos AKL, Tenório AS, Oliveira DA
Is it possible to sort the disability of individuals with migraine based on the International Classication of Functioning, Disability and Health? — A Scoping Review
were related to the characterization of samples in relation
to photophobia and phonophobia.
Past studies have demonstrated the relation of migraine
with other triggering factors such as climate change and
cigarette smoking
and have also demonstrated the
relationship of crises triggered by climate changes, which
evidences the importance of being better evaluated in the
relations of migraine with environmental factors in which
individuals such as in the study population are included.
Furthermore, another relevant aspect is that osmophobia
(the fear of smell) is a characteristic that can be present
in individuals with