Postgraduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Brazil.
Pelopidas Silveira Hospital, Recife, Brazil.
Headache. 2020 May;60(5):954-966. doi: 10.1111/head.13806. Epub 2020 Apr 15.
The objectives of this study are to study osmophobia and odor-triggered headaches among headache pediatric patients.
Achieving the correct diagnosis for headaches in younger children can be challenging. The presence of osmophobia could constitute a helpful piece of information for making the correct diagnosis of headaches among adults.
This was a cross-sectional study. Children and adolescents with headaches who were seen consecutively at a pediatric outpatient service and had at least 1 headache attack over the previous 12 months were included. We used a semi-structured questionnaire, Pediatric Migraine Disability Assessment, State-Trait Anxiety Inventory, and Children's Depression Inventory.
About 300 patients were included; 253 had migraine, 47 had a tension-type headache; 137 had osmophobia during headaches (135 were migraineurs). "Osmophobia during headaches" for diagnosing migraine: Sensitivity: 54.4% (95% CI: 48.2%-60.5%); specificity: 95.8% (95% CI: 85.8%-98.8%); positive predictive value (PPV): 98.5% (95% CI: 94.8%-99.6%); negative predictive value (NPV): 28.5% (95% CI: 22.0%-36.0%). Osmophobia was associated with higher intensity (OR: 2.90; 95% CI: 1.63, 5.15; P < .001) and duration of the headache (OR: 5.73; 95% CI: 2.29, 14.3; P < .001) and with vomiting (OR: 3.56; 95% CI: 1.83, 6.96; P < .001) (logistic regression). There were 62 patients (all of them migraineurs) with odor-triggered headaches: sensitivity for diagnosing migraine: 24.9% (95% CI: 19.9%-30.6%); specificity: 100% (95% CI: 92.4%-100%), PPV: 100% (95% CI: 94.8%-100%), NPV: 20% (95% CI: 16%-26.0%). Odor-triggered headaches were associated with higher intensity (OR: 3.47; 95% CI: 1.64, 7.35; P = .001) and duration of the headache (OR: 3.28; 95% CI: 1.37, 7.86; P = .001), vomiting (OR: 2.37; 95% CI: 1.19, 4.74; P = .014), and phonophobia (OR: 2.40; 95% CI: 1.08, 5.32; P = .031) (logistic regression). Osmophobia was associated with higher-impact migraine (OR: 4.65; 95% CI: 1.30, 16.6; P = .018) and emergency care (OR: 4.65; 95% CI: 1.81, 12.0; P = .001) (logistic regression).
Osmophobia and odors as triggers for headaches are useful in diagnosing migraine and are markers for the severity of migraine in the pediatric population.
本研究旨在研究小儿头痛患者的嗅觉恐惧症和气味触发头痛。
对于年龄较小的儿童，实现头痛的正确诊断可能具有挑战性。嗅觉恐惧症的存在可能有助于成人头痛的正确诊断。
这是一项横断面研究。连续在儿科门诊就诊且在过去 12 个月内至少有 1 次头痛发作的头痛患儿纳入研究。我们使用半结构式问卷、儿童偏头痛残疾评估量表、状态特质焦虑量表和儿童抑郁量表。
约有 300 名患者入选；253 名患有偏头痛，47 名患有紧张型头痛；137 名在头痛时出现嗅觉恐惧症（135 名是偏头痛患者）。“头痛时的嗅觉恐惧症”用于诊断偏头痛：敏感性：54.4%（95%CI：48.2%-60.5%）；特异性：95.8%（95%CI：85.8%-98.8%）；阳性预测值（PPV）：98.5%（95%CI：94.8%-99.6%）；阴性预测值（NPV）：28.5%（95%CI：22.0%-36.0%）。嗅觉恐惧症与更高的头痛强度（OR：2.90；95%CI：1.63，5.15；P<0.001）和持续时间（OR：5.73；95%CI：2.29，14.3；P<0.001）和呕吐（OR：3.56；95%CI：1.83，6.96；P<0.001）相关（logistic 回归）。有 62 名患者（均为偏头痛患者）有气味触发头痛：诊断偏头痛的敏感性：24.9%（95%CI：19.9%-30.6%）；特异性：100%（95%CI：92.4%-100%），PPV：100%（95%CI：94.8%-100%），NPV：20%（95%CI：16%-26.0%）。气味触发头痛与更高的头痛强度（OR：3.47；95%CI：1.64，7.35；P=0.001）和头痛持续时间（OR：3.28；95%CI：1.37，7.86；P=0.001）、呕吐（OR：2.37；95%CI：1.19，4.74；P=0.014）和恐声症（OR：2.40；95%CI：1.08，5.32；P=0.031）相关（logistic 回归）。嗅觉恐惧症与偏头痛的高影响程度（OR：4.65；95%CI：1.30，16.6；P=0.018）和急诊治疗（OR：4.65；95%CI：1.81，12.0；P=0.001）相关（logistic 回归）。
嗅觉恐惧症和气味作为头痛的触发因素有助于偏头痛的诊断，是儿科人群偏头痛严重程度的标志物。
