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The effect of inhaling green apple fragrance to reduce the severity of migraine: A pilot study
Abstract
Objective: Since certain ambient odors reduce anxiety - one such odor, green apple, affects emotions positively in other contexts - we hypothesized that if the patient sniffs its fragrance during an at- tack, the severity of migraine symptoms may be reduced. Design: For three headache episodes, 50 patients with chronic cephalalgia were asked to rate the severity of their head- aches at the onset and 10 minutes later. The first and third episodes served as controls. During the second, subjects sniffed green-apple fragrance from an inhaler. Setting: Outpatient clinic. Patient selection: Fifty chronic headache patient volunteers. Main outcome measures: Patient's subjective ratings of severity of pain at onset and 10 minutes later. Results: Those patients with normal olfactory abilities and who liked the fragrance, judged that it slightly reduced the severity of their symptoms (p < 0.03). Conclusion: These data indicate that green apple odorant may be useful as an adjuvant therapy in managing chronic headache.
While the determination of age has been primarily mediated visually, the ambient odour may also have an influence. To investigate this in a single blinded, randomised fashion, thirty-seven subjects (age average of 28 years, ranging from 13 years to 71 years) estimated the age of models in twenty photographs while wearing either blank masks or masks impregnated with a grape, cucumber or grapefruit aroma. The grape odour (p = 0.198) and the cucumber odour (p = 0.244) had no significant effects. The grapefruit aroma reduced subjects' perception of overall models' ages by an average of approximately three years (p = 0.025) and of female models' age by five years (p = 0.053). Possible mechanisms whereby the grapefruit aroma created a rejuvenating effect with relationship to perceived age includes induction of positive effect, expectancy effect, sexual arousal, anxiolysis, change in cognitive set and odour induced visual distortion. The perceived rejuvenating effect of the grapefruit aroma may have utility in facilitating intergenerational communication or act as an adjuvant like Botoxial toxins in cosmetic and pharmaceutical usage to affect age perception.
The purpose of this study was to assess the effects of odorants on men's perception of a woman's weight. A five foot nine inch (1.75 m), 245 pound (111 kg) woman model wore a floral-spice odorant, a citrus-floral odorant, and a sweet pea and lily of the valley odorant. One hundred and ninety-nine males assessed the woman's weight. Compared to the non-odorant control perceived weight, the floral-spice mixture reduced the men's perception of the woman's weight by 4.1 pounds (1.86 kg) (p = 0.02). In those who viewed this odour hedonically positively, the reduction in weight was 12 pounds (5.44 kg) (p = 0.02). Wearing a floral-spice odour can reduce a woman's perceived weight by as much as seven percent.
Introduction As nursing has developed and its body of knowledge has grown, specialised nursing practice has evolved into a range of nursing specialisms. Clinical Nurse Specialists (CNS) were first described in the North American nursing literature in 1938, and North America has led the field in developing this area of nursing. CNS posts were created to keep expert nurses in clinical practice and to improve patient care (Sparacino, 2000), and this role for nurses has survived, despite changing health care systems. The Growth of Clinical Nurse Specialists in the UK Throughout the 1980s the first wound healing CNSs emerged from other posts and backgrounds, including research posts, teaching posts, ward sister posts, and community nursing posts. The number of wound healing CNSs has increased over the past twenty years. In relation to one of the sub groups of such specialists, the Tissue Viability Nurse (TVN) there is evidence of remarkable growth (Flanagan, 1997). She reports that the first TVN came into post in 1983 and up until the end of 1991 the number of these nurses appointed annually grew slowly. From 1992 on there was rapid growth. Many have made contributions to founding societies and journals; lecturing and writing textbooks and articles together; organising and presenting at conferences; running workshops; making videos; developing courses, and teaching and examining locally, nationally and internationally. Sometimes work independently, but often come together and have been instrumental in the evolution of a network of CNSs. Finnie (2002) estimates that there are currently around 400 tissue viability nurses, illustrating further growth in the numbers of CNSs in this area. Networking provides opportunities for benchmarking clinical practice and standards of care can be fed back into clinical environments and so organisations can support each other and grow together. Education and Training In the UK there is no mandatory requirement that CNSs be educated to Masters level (Manley, 1993). Wright (1995) argued that a more formal approach to education and training was needed, to adopt a coordinated approach by governing bodies in supporting nursing development, and that nurses are largely unprepared for the responsibilities that autonomous practice brings. With time, the need for particular training and job specifications for CNS practice have in some ways been addressed and Government strategies and bodies governing nursing now provide some guidance and support (United Kingdom Central Council, 1999a, 1999b; Department of Health, 1999). The CNS is one type of nurse working at a higher level of practice, and the United Kingdom Central Council planned to regulate such nurses, possibly through assessment of clinical skills and registration.
This article discusses the many factors that can influence odor perception, including association, expectancy and context and a good number of perceiver response variables such as age and gender as well as personality type. A historical background is included together with a wide range of references.
The exact mechanism of action of beta blockers in migraine remains undetermined. An effect on the central nervous system (CNS) might be a factor. The evidence from the literature indicates that the anatomical and chemical targets for these drugs are present in the mammalian brain, that they readily penetrate the brain, and that they may modify CNS functions. The present study shows that psychomotor tests and contingent negative variation (CNV), an event related slow cerebral potential, both of which are abnormal in untreated migraineurs, tend to normalize after treatment with the beta blocker metoprolol. Moreover, a strong positive correlation was found between the amplitude of CNV and the clinical efficacy of beta blockers in migraineurs. One might hypothesize that a hyperactive central catecholaminergic state in migraine might be the common denominator between reduced performance on psychomotor testing and enhanced CNV. It remains to be determined whether this is due to hyperactivity of catecholaminergic neurons or to hypersensitivity of catecholamine receptors.
Three patients with olfactory hallucinations related to migraine are described.
Nervous connections between the trigeminal ganglia and cerebral blood vessels have recently been identified in experimental animals and have been termed the trigeminovascular system. Existence of this system in humans is inferential. Trigeminovascular neurons and their peripheral unmyelinated nerve fibers contain the neurotransmitter peptide substance P. Most newly synthesized substance P is transported from ganglion cell bodies to afferent nerve fibers, where depolarization-induced release of neurotransmitter into the wall of the cerebral blood vessel occurs. Substance P dilates pial arteries, increases vascular permeability, and activates cells that participate in the inflammatory response. The relationship of trigeminovascular fibers to the pathogenesis of vascular head pain sheds light on possible mechanisms of migraine and other central nervous system conditions associated with headache and inflammation.
Objective: To explore physiological effects of a water supply containing 0 to 2441 parts per billion trichloroethylene (TCE). Design and Patient Selection: A questionnaire was mailed to 103 residents of a western illinois community on the Rock River. All responded and were selected for study along with 15 additional residents; 12 were dropped leaving 106. All were involved in a legal action against the nearby industrial plant that reportedly ejected TCE into the river contaminating the wells that supplied the community's water. Setting: Outpatient clinic for chronic pain. Main Outcome Measures: Physical, neurological, psychological, and subjective data. Results: The most common complaint was headache; 51 of 103 subjects surveyed mentioned severe or frequent headaches. Two years later, 66 of the 106 subjects complained of headaches. After excluding those diagnosed using known criteria, 57 patients remained who had headaches that might be ascribed to TCE exposure. Of these, 47 had a family history of headaches. Conclusion: Their common exposure to TCE, a genetic disposition, a learned response to stress, or a combination of factors may account for the head aches, which were bifrontal, throbbing, gradual more often than sudden in onset, without sex predominance, and without associated features. TCE may cause headache at lower levels of exposure than previously reported.
Despite the pervasive problem of obesity and the ex-penditUre of billions of dollars devising methods of losing weight. no studies have been published on the role of the ol-factory sense in determining weight. To assess the effect of inhalation of certain aromas upon weight control. we studied 3193 overweight volunteers. Their average age was 43 years, average height 65 inches. and average weight 217pounds. Each was given <:'01 inhale. containing a blend of odorants and in-structed to inhale three times in each nostril whenever feeling hungry. New inhalers containing a new blend of odorants were supplied each month over a period of 6 months. Those subjects whose test scores showed they had good olfactory abilities and who use their inhalers frequently. ate 2 to 4 meals a day, felt bad about overeating, but did not feel bad about themselves lost nearly 5 .pounds, or 2% of body weight per month. It appears possible that inhalation of certain aromas can induce sustained weight loss over a 6-month period.
The structure and connections of areas within the olfactory peduncle (anterior olfactory nucleus and tenia tecta) have been examined. The anterior olfactory nucleus has been divided into external, lateral, dorsal, medial, and ventro‐posterior parts. In spite of the term nucleus which is applied to these areas, all of them contain pyramidal‐type cells with apical and basal dendrites oriented normal to the surface, and are essentially cortical in organization. Experiments utilizing retrograde and anterograde axonal transport of horseradish peroxidase (HRP) have demonstrated that each of these parts of the anterior olfactory nucleus possesses a unique pattern of afferent and efferent connections with other olfactory areas. All subdivisions have projections to both the ipsilateral and contralateral sides, although the ipsilateral projection of the pars externa (to the olfactory bulb) is extremely light. Interestingly, crossed projections are in each case directed predominantly to areas adjacent to the homotopic areas.
Two primary subdivisions may also be distinguished in the tenia tecta: a dorsal part composed largely of tightly packed neurons which closely resemble the granule cells of the dentate gyrus (bushy apical but no basal dendrites) and a ventral part which contains predominantly pyramidal‐type cells. The connections of these two parts are also very different. The ventral tenia tecta receives substantial projections from the olfactory bulb, pars lateralis of the anterior olfactory nucleus, piriform cortex and lateral entorhinal area. It gives off a heavy return projection to the pars lateralis and lighter projections to the olfactory bulb, piriform cortex and olfactory tubercle. The dorsal tenia tecta receives a heavy projection from the piriform cortex, but none from the olfactory bulb. A few cells in the dorsal tenia tecta are retrogradely labeled from HRP injections into the medial aspect of the olfactory peduncle (involving the ventral tenia tecta and adjacent areas), but none are labeled from the other olfactory areas that have been injected.
An area on the dorsal aspect of the olfactory peduncle that differs significantly from the anterior olfactory nucleus, tenia tecta and piriform cortex in terms of its connections and cytoarchitecture has been termed the dorsal peduncular cortex. The most striking feature of this area is its very heavy reciprocal connection with the entorhinal cortex, although it is also reciprocally connected with the olfactory bulb and piriform cortex and projects to the olfactory tubercle.
Cells in layer I of the medial and ventral aspects of the olfactory peduncle have been retrogradely labeled from HRP injections into the olfactory tubercle and lateral hypothalamic area. These cells overlie the ventral tenia tecta, medial part of the anterior piriform cortex and pars ventro‐posterior and pars lateralis of the anterior olfactory nucleus, but do not appear to be distributed in relation to the cytoarchitectonic boundaries.
Possible functional roles of the areas within the olfactory peduncle have been discussed.
SYNOPSIS
Many investigators have described olfactory dysfunction among migraineurs. Olfactory stimuli can precipitate migraine, and olfactory hallucinations can occur as auras of migraines or as part of the symptom complex. Despite many reports linking olfactory phenomena and migraine, no evaluations of the olfactory abilities of migraineurs have been documented. To begin such assessments, sixty‐seven consecutive migraine patients were given Pyridine odor threshold tests. Twelve of them (18%) scored as hyposmic or anosmic. In comparison, 1% of the general population of the U.S. is hyposmic or anosmic. Aside from possible diagnostic or methodological error, several possibilities may account for our result: migraine may induce olfactory pathology; olfactory pathology may induce migraine, or; a common pathogen may induce both olfactory dysfunction and migraine. The association of migraine with the emotional component of the limbic system has long been recognized, and our results strengthen its association with the olfactory component as well. Headache patients should be tested for olfactory loss and warned of such risks as inability to detect gas leaks and spoiled food.
SYNOPSIS
In a consecutive series of 46 female new referrals to a migraine clinic, 17 patients (37%)complained of increased irritability and/or depression in association with more than 50% of their migraine attacks. This was not related to the attack frequency or duration. Sixteen patients (33 %) met DSM-III criteria for a current diagnosis of an affective syndrome and when present this was significantly associated with these complaints.
Immunoreactivities for gamma-aminobutyric acid (GABA) and the dopamine-synthesizing enzyme tyrosine hydroxylase (TH) were localized ultrastructurally and colocalized at the light microscopic level in neurons of the rat main olfactory bulb. By means of a simultaneous indirect immunofluorescence technique, GABA and TH immunoreactivities were found to coexist in a large number of neurons in the glomerular and external plexiform layers. Virtually all the TH-immunoreactive periglomerular neurons also contained GABA immunoreactivity (GABA-I) while there was an additional number of GABA-immunoreactive periglomerular cells (27%) which did not contain TH immunoreactivity (TH-I). In contrast, the numerous tufted-type neurons in the glomerular and superficial external plexiform layers which contained TH-I did not contain GABA-I. In the external plexiform layer (EPL), 41% of the immunoreactive neurons contained GABA-I alone, 24% contained TH-I alone, and 35% contained both. EPL neurons containing GABA-I only or both GABA-I and TH-I never exhibited tufted cell morphological characteristics and were generally of the short-axon type. Electron microscopic examination of GABA-I and TH-I elements in the glomerular layer detected morphologically similar periglomerular perikarya and intraglomerular processes immunoreactive for each substance and other neurons and processes of the same type containing neither GABA-I or TH-I. These data indicate that the classical neurotransmitters GABA and dopamine coexist in large numbers of neurons in the rat main olfactory bulb including characteristic periglomerular cells and certain other local-circuit neuronal types.
An 8-month, double-blind, placebo-controlled, crossover trial of flunarizine in the prophylaxis of migraine has been performed in 70 children. After 4 weeks of medication-free base-line observation, 35 children (group A) received flunarizine (5 mg/day) and 35 (group B) received placebo over a 12-week period. After a 4-week washout they crossed treatments for another 12 weeks. Sixty-three patients completed the trial. In both groups flunarizine significantly reduced the frequency and average duration of headache attacks. In group A efficacy was maintained after placebo crossover for the last 4 months of the study. Five subjects in group B stopped placebo because of ineffectiveness; two children in group A discontinued flunarizine treatment, one because of excessive daytime sedation and the other because therapy was ineffective. The main side effects were daytime sedation and weight gain. It is concluded that flunarizine is an effective drug for the treatment of childhood migraine. In a study of this length no serious side effects were discovered.
The brainstem nucleus, locus coeruleus (LC), is the major, if not the sole, source of noradrenergic (NE) innervation of the telencephalon. It is generally held that LC neurons project diffusely to the entire neuroaxis and this had been the basis for theories that postulate 'general' functions (sleep, attention, learning, etc.) for LC. We report that at least 40% of all LC neurons project to the olfactory bulb; the projection is almost 10 times greater than to any other part of the cerebral cortex. This unsuspectedly rich LC-olfactory bulb connection is consistent with current theories which implicate LC neurons in heightened sensory vigilance and trophic regulation of connectional development and plasticity.
Osmophobia or hyperosmia featured in 25 of 50 migraineurs during the headache phase of their attacks. Pleasant or unpleasant odours could precipitate migraines in 11 patients in this series. Other sensory disturbances and precipitants were also studied. Neurological precipitation of attacks provides further support for a primary neural rather than a vascular pathogenesis of migraine.
To the Editor.
—Olfactory hallucinations, most commonly recognized as aura in complex partial seizures, have been described as potential aura in migraine in a single adult.1 We have cared for a child and her mother in whom olfactory hallucinations were strikingly similar and were but one component in their migraine phenomenon.
Report of a Case.
—An 8-year-old girl had had unilateral biweekly throbbing headaches for two years. The headaches were commonly preceded by a smell of gas, burning cookies, or wood chips. The aura was so prominent that the family's home was investigated for natural gas leaks several times. The headaches were most common over the right temporal region, and would begin at any time of the day or night, and were usually associated with nausea and/or vomiting.As an infant, this girl had been subject to unexplained recurrent bouts of vomiting and dizziness. Two years prior to neurologic
Although nausea and vomiting are diagnostic migraine symptoms, most patients can take tablets by mouth and a few say they can eat some food. This study was conducted to determine the proportion who could eat or drink, what was consumable and with what effect. One-hundred-and-nine migraineurs were asked what they could eat or drink at the beginning or height of their attacks; 59 could not take any food by mouth, but 50 could eat during the headache phase of their migraine attacks. Four ate normally, 5 took smaller amounts of their normal dietary intake, and 3 took lighter meals. Dry, carbohydrate foods were consumable by the remaining 38: a few had specific cravings, most stated the precise variety which, when eaten, reduced nausea, headache, other symptoms or length of attacks. Patients should therefore be encouraged to eat what they can tolerate, with their tablets taken as early as possible after the onset of attacks. Simultaneous nausea, tolerance or even craving for specific foods occur in other conditions, particularly high altitude headaches which share other features of migraine attacks. The observations in this paper support the notion that migraine is a central neuronal metabolic disturbance.