Osmophobia in primary headache patients: associated symptoms and response to preventive treatments

Background 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. Methods 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. Results 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. Conclusions 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.

Why Patients Do Not Comply With Headache Diaries?

Background/ObjectiveHeadache calendars are part of good clinical practice in headache clinics. However, patients’ compliance is rather variable. We aim to identify factors associated with poor compliance.MethodsConsecutive patients observed in follow-up visits of a tertiary headache center were divided into two groups; with a fullfilled calendar (Calendar compliers, CC) and without calendar (Calendar noncompliers, CNC). Incomplete /forgotten records were excluded. Demographic and clinical variables were compared, and CNC were asked the reasons for not filling the calendar. ResultsFrom 93 patients (45.6±13.3 years, on average; 83 females), the majority with migraine (96.8%), 61.3% were CC. CNC were more likely to have medication overuse (34.5% vs. 12.3%, p=0.01) and had a tendency to be paid workers (79.3% vs. 52.6%, p=0.05) compared to CC.Most CC considered calendars useful to improve doctors and patients knowledge about headaches.ConclusionsAlthough these results need to be evaluated in other contexts, they suggest that patients with medication overuse have a more denial attitute towards headache records and may need additional reinforcement.

Why Patients Do Not Comply With Headache Diaries?

Background: Headache calendars are part of good clinical practice in headache clinics. However, patients’ compliance is rather variable. We aim to identify factors associated with poor compliance. Methods: Consecutive patients observed in follow-up visits of a tertiary headache center were divided into two groups; with a fullfilled calendar (Calendar compliers, CC) and without calendar (Calendar noncompliers, CNC). Incomplete / forgotten records were excluded. Demographic and clinical variables were compared, and CNC were asked the reasons for not filling the calendar. Results: From 93 patients (45.6±13.3 years, on average; 83 females), the majority with migraine (96.8%), 61.3% were CC. CNC were more likely to have medication overuse (34.5% vs. 12.3%, p=0.01) and had a tendency to be paid workers (79.3% vs. 52.6%, p=0.05) compared to CC. Most CC considered calendars useful to improve doctors and patients knowledge about headaches.Conclusions: Although these results need to be evaluated in other contexts, they suggest that patients with medication overuse have a more denial attitute towards headache records and may need additional reinforcement.

Effect of lockdown during COVID-19 on migraine: A longitudinal cohort study

Background The objective of this study was to assess whether migraine-related outcomes changed during intelligent lockdown when compared with the prior period. Methods This was a cohort study evaluating the first month of intelligent lockdown in the Netherlands (12 March to 8 April 2020) compared with one baseline month (13 February to 11 March 2020). We identified 870 migraine patients treated at the Leiden Headache Center with headache e-diaries during the period of interest. Adherence to the e-diary had to be ≥80%, yielding 592 enrolled patients. Results Intelligent lockdown led to a decrease in monthly migraine days (−0.48; 95% CI: −0.78 to −0.18, p = 0.002) and acute medication days (−0.48; 95% CI: −0.76 to −0.20, p < 0.001), and an increase in general well-being (0.11; 95% CI: 0.06 to 0.17, p < 0.001). No differences in non-migrainous headache days and pain coping were observed. Consistent results were found in a subset that was followed for 4 months. Conclusions Our findings imply that intelligent lockdown measures can improve migraine disability despite of the potential negative effects of COVID-19 and lockdown. We hypothesise that this effect is a combined result of working from home, scaling down demanding social lives, and freedom to choose how to organise one’s time.