Applied Neurophysiology and Pain Unit, SMBNOS Department, Aldo Moro University, Bari, Italy.
J Headache Pain. 2021 Sep 18;22(1):109. doi: 10.1186/s10194-021-01327-2.
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.
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.
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.
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.
嗅觉恐惧症在原发性头痛中很常见，偏头痛的发病率较高。本研究旨在评估在三级头痛中心选择的原发性头痛患者队列中嗅觉恐惧症患者的患病率和临床特征。第二个目的是验证嗅觉恐惧症在偏头痛患者亚队列预防治疗反应中的可能预测作用。
这是一项基于三级头痛中心收集数据的观察性回顾性队列研究。我们选择了年龄在 18-65 岁之间的患者，诊断为无先兆偏头痛（MO）、有先兆偏头痛（MA）或慢性偏头痛（CM）、紧张性头痛（TTH）；和丛集性头痛（CH）。我们还选择了偏头痛患者的亚队列，他们根据意大利指南规定，在 3 个月随访后接受预防治疗。如果患者在至少 20%的头痛发作中报告了这种症状，则认为其有嗅觉恐惧症。其他考虑的变量包括：头痛频率、偏头痛残疾评估（MIDAS）、感觉异常症状检查表、自评抑郁量表、自评焦虑量表、数字评定量表-NRS 评估的疼痛强度（0 到 10 分）。
37.9%的患者报告有嗅觉恐惧症（444 例有嗅觉恐惧症，726 例无嗅觉恐惧症）。嗅觉恐惧症在不同的偏头痛亚型患者中更为常见，而在发作性紧张型头痛和丛集性头痛患者中则不存在（卡方检验 68.7，自由度 7，p<0.0001）。有嗅觉恐惧症的头痛患者头痛持续时间更长（F4.91，p=0.027；焦虑程度更严重（F7.56，p=0.007）、抑郁（F5.3，p=0.019）、感觉异常（F6，p=0.014）、头痛强度（F8.67，p=0.003）。有嗅觉恐惧症的紧张型头痛患者（n=21）头痛发作更频繁，焦虑程度更高。共有 711 例偏头痛患者在治疗 3 个月后接受了随访。有嗅觉恐惧症和无嗅觉恐惧症的患者偏头痛的主要特征变化相似。
本研究证实了偏头痛患者嗅觉恐惧症的患病率，同时也表明其存在于慢性紧张型头痛病例中，这些病例有慢性头痛和焦虑。嗅觉恐惧症与中央敏化的症状有关，如感觉异常。它与一线预防方法后偏头痛的演变无关。
