A prospective study on osmophobia in migraine versus tension-type headache in a large series of attacks

Background In literature, osmophobia is reported as a specific migrainous symptom with a prevalence of up to 95%. Despite the International Classification of Headache Disorders 2nd edition proposal of including osmophobia among accompanying symptoms, it was no longer mentioned in the ICHD 3rd edition. Methods We conducted a prospective study on 193 patients suffering from migraine without aura, migraine with aura, episodic tension-type headache or a combination of these. After a retrospective interview, each patient was asked to describe in detail osmophobia, when present, in the following four headache attacks. Results In all, 45.7% of migraine without aura attacks were associated with osmophobia, 67.2% of migraineurs reported osmophobia in at least a quarter of the attacks. No episodic tension-type headache attack was associated with osmophobia. It was associated with photophobia or phonophobia in 4.3% of migraine without aura attacks, and it was the only accompanying symptom in 4.7% of migraine without aura attacks. The inclusion of osmophobia in the ICHD-3 diagnostic criteria would enable a 9.0% increased diagnostic sensitivity. Conclusion Osmophobia is a specific clinical marker of migraine, easy to ascertain and able to disentangle the sometimes challenging differential diagnosis between migraine without aura and episodic tension-type headache. We recommend its inclusion among the diagnostic criteria for migraine as it increases sensitivity, showing absolute specificity.

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Nosographic analysis of osmophobia and field testing of diagnostic criteria including osmophobia

Cephalalgia ◽

10.1177/0333102418771375 ◽

2018 ◽

Vol 39 (1) ◽

pp. 38-43 ◽

Cited By ~ 6

Author(s):

Mona Ameri Chalmer ◽

Thomas Folkmann Hansen ◽

Jes Olesen

Keyword(s):

Diagnostic Criteria ◽

Migraine Without Aura ◽

Field Testing ◽

Tension Type Headache ◽

International Classification ◽

Headache Disorders ◽

Probable Migraine ◽

Type Headache ◽

Headache Patients

Introduction Osmophobia has been suggested as an additional symptom of migraine without aura, and a high prevalence of osmophobia of up to 50% has been reported in the literature. We conducted a nosographic study of osmophobia in all migraineurs and tension-type headache patients and a field testing of suggested diagnostic criteria of osmophobia, presented in the appendix of the second edition of The International Classification of Headache Disorders and suggested by Silva-Néto et al. and Wang et al ., in migraine without aura and tension-type headache patients (n = 1934). Materials and methods Each patient received a validated semi-structured interview. All subjects fulfilled the diagnostic criteria of the second edition of The International Classification of Headache Disorders for migraine or tension-type headache. Statistical analyses were performed using statistical software R. The statistical R package “Caret” was used to construct a confusion matrix and retrieve sensitivity, which is defined as the suggested criteria’s ability to correctly diagnose migraine without aura patients, and specificity, defined as the suggested criteria’s ability to not wrongly diagnose tension-type headache patients. Results Osmophobia was present in 33.5% of patients with migraine with aura, in 36.0% of patients with migraine without aura, and in 1.2% of patients with tension-type headache. All migraineurs with osmophobia also fulfilled the current criteria for migraine by having nausea or photophobia and phonophobia. The appendix criteria had a sensitivity of 0.96 and a specificity of 0.99 for migraine without aura, and a sensitivity of 0.65 and a specificity of 0.99 for probable migraine without aura. Both the criteria by Silva-Néto et al. and Wang et al. had a sensitivity of 0.98 and a specificity of 0.99 for migraine without aura, and a sensitivity of 0.66 and a specificity of 0.99 for probable migraine without aura. Discussion This study demonstrates the remarkable specificity of osmophobia. The criteria by Silva-Néto et al. and Wang et al. both had a higher sensitivity than the appendix criteria for migraine without aura; all three criteria had a low sensitivity for probable migraine without aura. However, neither the appendix criteria nor the criteria by Silva-Néto et al. or Wang et al. added any extra patients that would not have been diagnosed by the current diagnostic criteria for migraine. Osmophobia is a valuable symptom that may be useful to differentiate between migraine without aura and tension-type headache in difficult clinical cases. Conclusion Our results do not suggest that alterations of the current diagnostic criteria for migraine without aura are needed.

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A Population-Based Analysis of the Diagnostic Criteria of the International Headache Society

Cephalalgia ◽

10.1046/j.1468-2982.1991.1103129.x ◽

1991 ◽

Vol 11 (3) ◽

pp. 129-134 ◽

Cited By ~ 199

Author(s):

Birthe Krogh Rasmussen ◽

Rigmor Jensen ◽

Jes Olesen

Keyword(s):

Physical Activity ◽

Diagnostic Criteria ◽

International Headache Society ◽

Normal Subjects ◽

Population Based ◽

Tension Type Headache ◽

Headache Disorders ◽

Specific Proposal ◽

Accompanying Symptoms ◽

Type Headache

In 740 representative normal subjects a diagnostic headache interview and a neurological examination provided the necessary information to classify headache disorders according to the operational diagnostic criteria of the International Headache Society (IHS). Sixteen per cent (n = 119) had migraine, 78% (n = 578) tension-type headache. In migraineurs, pain was of a pulsating quality in 78%, severe in 85%, unilateral in 62%, and aggravated by routine physical activity in 96%. Tension-type headache was of a pressing quality in 78%, mild or moderate in 99%, bilateral in 90%, and 72% had no aggravation by physical activity. The accompanying symptoms of nausea, photo- and phonophobia occurred frequently and were usually moderate or severe in migraine subjects, and if present in subjects with tension-type headache, they were usually mild. Only two subjects had unclassifiable headache. The IHS Classification is thus exhaustive. The criteria may be improved by mandatory demands to the criterion of pain intensity leaving other features of pain as supportive for the diagnosis and by including graded severity of accompanying symptoms. A specific proposal is given.

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Evaluation of diagnostic and prognostic value of clinical characteristics of Migraine and Tension type headache included in the diagnostic criteria for children and adolescents in International Classification of Headache Disorders - second edition

International Journal of Clinical Practice ◽

10.1111/ijcp.12024 ◽

2012 ◽

Vol 66 (12) ◽

pp. 1168-1177 ◽

Cited By ~ 8

Author(s):

I. Pacheva ◽

I. Milanov ◽

I. Ivanov ◽

R. Stefanov

Keyword(s):

Children And Adolescents ◽

Diagnostic Criteria ◽

Prognostic Value ◽

Clinical Characteristics ◽

Tension Type Headache ◽

International Classification ◽

Headache Disorders ◽

Type Headache ◽

Diagnostic And Prognostic Value

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Osmophobia in migraine classification: A multicentre study in juvenile patients

Cephalalgia ◽

10.1177/0333102410362928 ◽

2010 ◽

Vol 30 (12) ◽

pp. 1486-1494 ◽

Cited By ~ 20

Author(s):

D De Carlo ◽

L Dal Zotto ◽

E Perissinotto ◽

L Gallo ◽

M Gatta ◽

...

Keyword(s):

Migraine Without Aura ◽

Young Patients ◽

Tension Type Headache ◽

New Approach ◽

History Of ◽

Juvenile Headache ◽

Accompanying Symptoms ◽

Type Headache ◽

New Diagnosis

Aims: This study was planned to investigate the diagnostic utility of osmophobia as criterion for migraine without aura (MO) as proposed in the Appendix (A1.1) of the International Classification of Headache Disorders (ICHD-II, 2004). Methods: We analysed 1020 patients presenting at 10 Italian juvenile headache centres, 622 affected by migraine (M) and 328 by tension-type headache (TTH); 70 were affected by headache not elsewhere classified (NEC) in ICHD-II. By using a semi-structured questionnaire, the prevalence of osmophobia was 26.9%, significantly higher in M than TTH patients (34.6% vs 14.3%). Results: Osmophobia was correlated with: (i) family history of M and osmophobia; and (ii) other accompanying symptoms of M. By applying these ‘new’ criteria, we found an agreement with the current criteria for the diagnosis of migraine without aura (MO) in 96.2% of cases; 54.3% of previously unclassifiable patients received a ‘new’ diagnosis. Conclusions: In conclusion, this study demonstrates that this new approach, proposed in the Appendix (A1.1), appears easy to apply and should improve the diagnostic standard of ICHD-II in young patients too.

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Diagnostic value of combinations of symptoms of migraine and tension-type headache included in the diagnostic criteria for children and adolescents in the international classification of headache disorders 2nd edition

Folia Medica ◽

10.2478/folmed-2013-0027 ◽

2013 ◽

Vol 55 (3-4) ◽

pp. 46-55 ◽

Cited By ~ 2

Author(s):

Iliyana H. Pacheva ◽

Ivan G. Milanov ◽

Ivan S. Ivanov ◽

Rumen S. Stefanov

Keyword(s):

Physical Activity ◽

Children And Adolescents ◽

Diagnostic Criteria ◽

Diagnostic Value ◽

Tension Type Headache ◽

Headache Disorders ◽

Recurrent Headache ◽

Severe Intensity ◽

Type Headache

ABSTRACT AIM: To suggest diagnostic combinations of symptoms for migraine and tension type headache (TTH), and for differentiation of overlapping headache (classified as either migraine or TTH) through evaluation of the diagnostic value of combinations of characteristics included in the International Headache Society diagnostic criteria for migraine and TTH in children and adolescents. PATIENTS AND METHODS: The study comprised an epidemiological school-based study (412 of 1029 pupils with chronic / recurrent headache) and a clinical study conducted in the Pediatric Neurology Ward and outpatient clinic at Plovdiv Medical University Hospital (203 patients with chronic / recurrent headache). An inclusion criterion was at least two episodes of headache during the last year. Exclusion criteria were: headache occurring only during acute infections; withdrawal of informed consent. Headache was classified according to the International Classification of Headache Disorders 2nd edition (ICHD-II) The diagnostic value of all combinations of items in criteria C and D for migraine and TTH was measured by sensitivity, specificity, and odds ratio. RESULTS: The combination “unilateral location, severe intensity, aggravation by physical activity” had 100% specificity for migraine. The combination “bilateral location, pressingtightening quality, mild intensity, no aggravation by physical activity” had 100% specificity for TTH. The combinations: “migrainous location, severe intensity, aggravation by physical activity”, “severe intensity, nausea”, “pulsating quality, nausea”, “pulsating quality, migrainous location, aggravation by physical activity” seemed to pose the greatest risk for developing migraine. These combinations - “no nausea, no photophobia”, “bilateral location, mild intensity and either no aggravation by physical activity or pressing-tightening quality, or no nausea or no photophobia” increased the most the TTH risk. Using these combinations as additional criteria for overlapping headache we classi ed 50% of overlapping headache as TTH and 8.3% as migraine. CONCLUSIONS: Some combinations of symptoms clarify the diagnosis of migraine and TTH. More than 50% of overlapping headache could be differentiated as TTH or MWA by the proposed combinations.

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Perinatal outcomes in women affected by different types of headache disorders: A prospective cohort study

Cephalalgia ◽

10.1177/03331024211029236 ◽

2021 ◽

pp. 033310242110292

Author(s):

Isabella Neri ◽

Daniela Menichini ◽

Francesca Monari ◽

Ludovica Spanò Bascio ◽

Federico Banchelli ◽

...

Keyword(s):

Migraine With Aura ◽

Gestational Age ◽

Small For Gestational Age ◽

Migraine Without Aura ◽

Perinatal Outcomes ◽

First Trimester ◽

Tension Type Headache ◽

Headache Disorders ◽

Aneuploidy Screening ◽

Type Headache

Objective This study aims to investigate pregnancy and perinatal outcomes in women with tension-type headache, migraine without aura and migraine with aura by comparing them to women without any headache disorders. Study design Prospective cohort study including singleton pregnancies attending the first trimester aneuploidy screening at the University Hospital of Modena, in Northern Italy, between June 2018 and December 2019. Results A total of 515 consecutive women were included and headache disorders were reported in 43.5% of them (224/515). Tension-type headache was diagnosed in 24.3% of the cases, while 14% suffered from migraine without aura and 5.2% from migraine with aura. Birthweight was significantly lower in women affected by migraine with aura respective to other groups, and a significantly higher rate of small for gestational age infants was found in tension-type headache (10.4%) and in migraine with aura (24.9%) groups respective to the others (p < 0.001). Moreover, the admission to the neonatal intensive care unit was significantly higher in all the headache groups (p = 0.012). Multivariate analysis showed that women presenting tension-type headache (OR 4.19, p = 0.004), migraine with aura (OR 5.37, p = 0.02), a uterine artery pulsatility index >90th centile (OR 3.66, p = 0.01), low multiple of the median (MoM) of Pregnancy-associated plasma protein-A (PAPP-A) (OR 0.48, p = 0.05) and high MoM of Inhibin-A (OR 3.24, p = 0.03) at first trimester, are independently associated with the delivery of small for gestational age infants when compared to women without headache disorders. Conclusion Migraine with aura and tension type headache expose women to an increased risk of delivering small for gestational age infants, in association with some utero-placenta markers evaluated at first trimester. These women with headache disorders have an additional indication to undergo first trimester aneuploidy screening and would possibly benefit from specific interventions.

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Field testing the alternative criteria for tension-type headache proposed in the third beta edition of the international classification of headache disorders: results from the Korean headache-sleep study

The Journal of Headache and Pain ◽

10.1186/1129-2377-15-28 ◽

2014 ◽

Vol 15 (1) ◽

Cited By ~ 4

Author(s):

Min Kyung Chu ◽

Soo-Jin Cho ◽

Jae-Moon Kim ◽

Sung-Hee Hwang

Keyword(s):

Field Testing ◽

Tension Type Headache ◽

International Classification ◽

Headache Disorders ◽

Sleep Study ◽

The Third ◽

Type Headache

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Associations between stress and migraine and tension-type headache: Results from a school-based study in adolescents from grammar schools in Germany

Cephalalgia ◽

10.1177/0333102410390397 ◽

2011 ◽

Vol 31 (7) ◽

pp. 774-785 ◽

Cited By ~ 31

Author(s):

Astrid Milde-Busch ◽

Astrid Blaschek ◽

Florian Heinen ◽

Ingo Borggräfe ◽

Inga Koerte ◽

...

Keyword(s):

Tension Type Headache ◽

Major Contributor ◽

Headache Disorders ◽

Behavioural Interventions ◽

School Based ◽

Different Types ◽

Stressful Experiences ◽

Type Headache ◽

Linear Regressions

Introduction: Stress is considered the major contributor to migraine and tension-type headache in adolescents. Previous studies have focused on general stressors, whereas the aim of the present study was to investigate associations between individuals’ stressful experiences and different types of headache. Methods: Adolescents from 10th and 11th grades of grammar schools filled in questionnaires. Stressful experiences were measured with the Trier Inventory of Chronic Stress. Type of headache was classified according to the International Classification of Headache Disorders. Linear regressions, adjusted for sex and grade, were calculated to estimate differences in stress scores that can be attributed to migraine, tension-type headache or miscellaneous headache. Results: A total of 1260 questionnaires were analysed. Tension-type headache, migraine and co-existing migraine plus tension-type headache were found in 48.7%, 10.2% and 19.8% of the participants. In subjects with migraine or co-existing migraine plus tension-type headache, high increases in stress scores were found in all investigated dimensions, whereas much weaker and inconsistent associations were found in subjects with tension-type headache only. Conclusions: The characteristic of migraine is more associated with stressful experiences than this is the case for tension-type headache. This suggests that adolescent migraine patients might especially benefit from behavioural interventions regarding stress.

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A Prospective Study of the Headache Phase in 32 Migraine with Aura Patients

Cephalalgia ◽

10.1046/j.1468-2982.2002.00388.x ◽

2002 ◽

Vol 22 (6) ◽

pp. 411-415 ◽

Cited By ~ 9

Author(s):

D Cologno ◽

P Torelli ◽

GC Manzoni

Keyword(s):

Prospective Study ◽

Clinical Features ◽

Migraine With Aura ◽

International Headache Society ◽

Case Series ◽

Tension Type Headache ◽

Pain Location ◽

Headache Centre ◽

Type Headache ◽

A Prospective Study

For an accurate description of the clinical features of the headache phase in migraine with aura (MA) attacks, we thought it useful to conduct a prospective study of consecutively referred MA patients seeking treatment at the Headache Centre of the University of Parma Institute of Neurology. The case series included 32 patients (22 women and 10 men). At the time of the first visit, each patient was given a questionnaire to be filled in at the next MA attack. Six patients (four women and two men) had attacks of migraine aura without headache. Among the remaining 26 patients (18 women and eight men), the duration of the headache phase was < 24 h in 23 (88.5%); pain location was bilateral in 14 (53.8%) and unilateral in 12, but occurring on the opposite side to aura only in one patient; pain intensity was mild or moderate in 13 (50.0%). The headache phase of MA appeared to have clinical features that differed widely from patient to patient and was consistent with the International Headache Society diagnostic criteria for migraine without aura in 26.9% of patients and for tension-type headache (TTH) in 23.1%.

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