Osmophobia in migraine classification: A multicentre study in juvenile patients
ABSTRACT 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).
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%).
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.
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.
- SourceAvailable from: Raimundo Pereira Silva-Néto
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- "In three comparative studies between migraine and tensiontype headache conducted with children and adolescents (aged 4 to 18 years) with headache    and in another study with adults , osmophobia was more prevalent in migraine patients, in a demonstration that it is a symptom of low sensitivity and high specificity for the differential diagnosis between these two forms of headache. The presence of osmophobia in juvenile patients with tension-type headache has prognostic value, since this form of headache may change to migraine during development   . "
ABSTRACT: Our objective was to determine the accuracy parameters of osmophobia in the differential diagnosis between migraine and tension-type headache. Migraine or tension-type headache patients, diagnosed according to the criteria of the International Classification of Headache Disorders-II, were interviewed about osmophobia during the crisis and in the period between episodes. We studied 200 migraine patients and 200 tension-type headache patients. During the crisis, osmophobia occurred in 86.0% (172/200) of patients with migraine and 6.0% (12/200) of those with tension-type headache. In migraine, osmophobia was associated with photophobia and phonophobia (57/172, 33.1%) or with nausea, photophobia and phonophobia (92/172, 53.5%) and presented high sensitivity (86.0%, 95% CI 80.2-90.3) and specificity (94.0%, 95% CI 89.5-96.7), with low percentages of false positives (6.5%, 95% CI 3.6-11.4) and negatives (13.0%, 95% CI 8.9-18.4). In the period between attacks, osmophobia was restricted to migraine patients (48/200, 24.0%). The areas under ROC curves were: 0.903 ± 0.017 to osmophobia during crisis; 0.784 ± 0.025 between crises; 0.807 ± 0.023 to photophobia/phonophobia, and 0.885 ± 0.017 to pain developed by odors. Osmophobia may be a specific marker to differentiate migraine from tension-type headache, which suggests its inclusion within the criteria to diagnose migraine.Journal of the neurological sciences 04/2014; 339(1-2). DOI:10.1016/j.jns.2014.01.040 · 2.26 Impact Factor
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ABSTRACT: Based on publications on migraine in the medical literature after 2004, the third edition of the International Classification of Headache Disorders (ICHD-3), with publication date early in 2013, will provide a framework to systematize those migraine forms that the second edition (ICHD-2) included in its Appendix. The most needed changes concern so-called chronic migraine. The revised ICHD-2 (ICHD-2R) did introduce appreciable changes to the ICHD-2 diagnostic criteria for chronic migraine. To be more relevant to actual clinical practice, the classification should discriminate between forms of migraine without aura depending on low, medium, or high frequency of attacks. The classification should include transformed migraine, an appellation that seems preferable to chronic migraine, in the group of migraine complications using extended time parameters compared with those currently used in ICHD-2R for chronic migraine. Finally, it should assess the opportunity of a different classification for medication-overuse headache.Current Pain and Headache Reports 03/2011; 15(3):170-6. DOI:10.1007/s11916-011-0188-0 · 2.26 Impact Factor
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ABSTRACT: Primary headache are one of the most common health complaints in children and adolescents, yet there remain significant gaps in our understanding of the underlying pathophysiology of these conditions. Recently, there have been several areas of research that have assisted with filling this gap in our knowledge. These areas include a better understanding of the disease characteristics including additional associated symptoms and the refinement of the description of related conditions and comorbidities; continued examination of the epidemiology of primary headaches; the progression of migraine across these developmental ages; the molecular and physiological changes; and the potential role for vitamins and cofactor deficiencies in the pathophysiology. These studies continue to add to our fund of knowledge on the basis of migraine and tension-type headache as primary neurological conditions and their impact on the developing brain.Headache The Journal of Head and Face Pain 02/2012; 52(2):327-32. DOI:10.1111/j.1526-4610.2011.02085.x · 3.19 Impact Factor