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Osmophobia and Odor‐Triggered Headaches in Children and Adolescents: Prevalence, Associated Factors, and Importance in the Diagnosis of Migraine
Author(s) -
Albanês Oliveira Bernardo Albérico,
Lys Medeiros Fabiola,
Sampaio RochaFilho Pedro Augusto
Publication year - 2020
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.13806
Subject(s) - headaches , migraine , medicine , pediatrics , nausea , vomiting , physical therapy , psychiatry
Objective The objectives of this study are to study osmophobia and odor‐triggered headaches among headache pediatric patients. Background 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. Methods 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. Results 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). Conclusions Osmophobia and odors as triggers for headaches are useful in diagnosing migraine and are markers for the severity of migraine in the pediatric population.