Headache and Osmophobia in Gas Station Workers Exposed to Gasoline Odor.

INTRODUCTION: Headache attacks may be triggered by several factors, among them odors, especially in migraine patients. OBJECTIVES: The aim of this study wasto determine the association between gasoline odor and headache attacks in patients with migraine or tension-type headache (TTH). SUBJECTS AND METHODS: The study was prospective, cross-sectional, with comparison of groups, using nonrandom sample and convenience. Fifty-two gas station workers diagnosed with migraine or TTH according to ICHD-3 criteria were interviewed on the relationship between gasoline odor and headache. RESULTS: Of the 52 gas station workers with headaches, there were 39 (75%) with migraine without aura and 13 (25%) with TTH. The age ranged from 19 to 50 years, with a mean of 29.5 ± 7.2 years. Osmophobia during headache attacks predominated in workers with migraine (29/39; 74.4%). The onset of headache due to odor exposure occurred in 23/39 (60%) of the workers with migraine and in 2/13 (15.4%) in TTH. These differences were statistically significant (χ2 = 7.4; p = 0.016). Osmophobia in the absence of pain (period between attacks) predominated in workers with migraine (17/39, 43.6%), but with no statistical value. CONCLUSIONS: Gas station workers diagnosed with migraine or TTH may experience osmophobia and headache triggered by the odor of gasoline.

Osmophobia and Odor-Triggered Headaches in Children and Adolescents: Prevalence, Associated Factors, and Importance in the Diagnosis of Migraine.

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.

May headache triggered by odors be regarded as a differentiating factor between migraine and other primary headaches?

Objectives The objective of this article is to characterize olfactory stimulation as a trigger of headaches attacks and differentiation between migraine and other primary headaches. Participants and methods The study was prospective and experimental, with comparison of groups. A total of 158 volunteers (73 men and 85 women) were diagnosed with primary headaches, according to the criteria of the International Classification of Headache Disorders, Third Edition (beta version) (ICHD-3ß). The study was conducted by two examiners; one of them was assigned to diagnose the presence and type of primary headache, while the other was responsible for exposing the volunteers to odor and recording the effects of this exposure. Results Of the 158 volunteers with headache, there were 72 (45.6%) cases of migraine and 86 (54.4%) with other primary headaches. In both groups, there were differences in headache characteristics (χ2 = 4.132; p = 0.046). Headache attacks (25/72; 34.7%) and nausea (5/72; 6.9%) were triggered by odor only in patients with migraine, corresponding to 19.0% (30/158) of the sample, but in none with other primary headaches (χ2 = 43.78; p < 0.001). Headache occurred more often associated with nausea ( p = 0.146) and bilateral location ( p = 0.002) in migraineurs who had headache triggered by odor. Headache was triggered after 118 ± 24.6 min and nausea after 72.8 ± 84.7 min of exposure to odor. Conclusions The odor triggered headache attacks or nausea only in migraineurs. Therefore, headache triggered by odors may be considered a factor of differentiation between migraine and other primary headaches and this trigger seems very specific of migraine.

Migraine, Osmophobia, and Anxiety.

OBJECTIVES: To evaluate the association between osmophobia and the characteristics of patients and their headaches, among migraine patients. METHODS: This was a cross-sectional study. Patients who consecutively sought medical attendance in a primary care unit were asked about their headaches over the last 12 months. Those who had migraine were included. A semi-structured interview, the Headache Impact Test and the Hospital Anxiety and Depression Scale were used. RESULTS: 147 patients had migraine; 78 had osmophobia; 60 had significant anxiety symptoms; and 78 had significant depression symptoms. The mean age of these patients was 43.2 years (± 13.7); 91.2% were women. The mean length of time with complaints of headache was 13.8 years (± 12). Among the migraine patients, those with anxiety, more years of headache history, and phonophobia presented significantly more osmophobia (multivariate logistic regression). CONCLUSION: Osmophobia in migraine patients is associated with significant anxiety symptoms, length of headache history, and phonophobia.

Osmophobia and Headaches in Primary Care: Prevalence, Associated Factors, and Importance in Diagnosing Migraine.

OBJECTIVES: The aims of this study were to investigate the prevalence of osmophobia among primary headaches, evaluate the association between osmophobia and the characteristics of patients and their headaches, and assess the usefulness of this symptom for diagnosing migraine. METHODS: This was a cross-sectional study in a primary care unit. Patients who consecutively sought medical attendance in a primary care unit were asked about headaches (convenience sample). Those who reported having had at least 1 episode of headache during the last 12 months were interviewed. Semi-structured interview, the Headache Impact Test, and the Hospital Anxiety and Depression Scale were used. RESULTS: Two hundred thirty-five patients had headaches, 147 patients had migraine (53% of them had osmophobia), and 87 had tension-type headache (11.5% of them had osmophobia), and 1 patient had an unclassifiable headache. Among the headache patients, those with migraine and more years of headache history presented significantly more osmophobia (multivariate logistic regression).The sensitivity and specificity of osmophobia for establishing a diagnosis of migraine were 53.1% and 87.5%. The positive predictive value and negative predictive value were 87.6% and 52.7%. CONCLUSION: We found high prevalence of osmophobia among migraine patients, and this complaint is useful in making the diagnosis of migraine in primary care. Osmophobia is associated with migraine and more years of headache history.

Odorant substances that trigger headaches in migraine patients.

OBJECTIVES: Our objective was to determine odorants that trigger migraine attacks and the time of onset of headache after exposure. METHODS: Migraine or tension-type headache patients, diagnosed according to the criteria of the International Classification of Headache Disorders-II, were interviewed about lifetime prevalence of headaches triggered by odors and time of onset of pain, after exposure of the patient to the odor. RESULTS: We studied 200 migraine patients and 200 tension-type headache patients. There were odor-triggered headaches after 25.5 ± 1.9 minutes of exposure in 70.0% (140/200) of migraine patients and none with tension-type headache, which ran at low sensitivity (70.0%, 95% CI 63.1-76.2) and high specificity (100.0%, 95% CI 97.6-100.0). Odor-triggered headaches are distributed in the following order of frequency: perfumes (106/140, 75.7%), paints (59/140, 42.1%), gasoline (40/140, 28.6%) and bleach (38/140, 27.1%). There was significance in the association of odor-triggered migraine, especially among perfume with cleaning (phi = -0.459), cooking (phi = 0.238), beauty products (phi = -0.213) and foul odors (phi = -0.582). CONCLUSIONS: Odorants, isolated or in association, especially perfume, may trigger migraine attacks after a few minutes of exposure.

Odors as triggering and worsening factors for migraine in men / Odores como fatores desencadeantes e de piora na enxaqueca de homens

OBJECTIVE: To assess the role of odors in triggering or worsening migraine in men. METHOD: Ninety-eight male migraineurs from the general population were assessed individually through questionnaires. Environmental factors relating to their migraine were reported, with special focus on the role of odors. RESULTS: Odors were the second most frequent triggering factor for migraine attacks (48 percent), behind stressful situations (59 percent). Likewise, odors were the second most frequent worsening factor (73 percent), just behind excessive light (74 percent). Thirty-three individuals (33.4 percent) stated that odors were both triggering and worsening factors for their migraine attacks. Perfume, cigarette smoke and cleaning products were the most frequent migraine-related odors reported by these male migraineurs. CONCLUSION: This was the first study to assess the role of odors in migraine exclusively in men. There was a high degree of odor-related migraine among these men, thus suggesting that patient education could alert such individuals to gender-related factors, since different triggering and worsening factors have been reported by males and females.

OBJETIVO: Avaliar o papel dos odores como fatores desencadeantes e de piora da enxaqueca em homens. MÉTODO: Noventa e oito homens com enxaqueca na população geral foram avaliados individualmente por questionários. Os fatores ambientais relacionados à enxaqueca foram relatados, com foco especial no papel dos odores. RESULTADOS: Os odores foram o segundo fator mais frequente no desencadeamento de crise de enxaqueca (48 por cento), atrás das situações de estresse (59 por cento). Da mesma forma, os odores foram a segunda causa mais frequente de piora das crises (73 por cento), apenas atrás do excesso de luminosidade (74 por cento). Trinta e três indivíduos (33,4 por cento) relataram que os odores eram tanto fatores desencadeantes quanto fatores de piora de suas crises de enxaqueca. Perfume, fumaça de cigarro e produtos de limpeza foram os odores mais relatados como sendo relacionados a enxaqueca pelos homens. CONCLUSÃO: Este foi o primeiro estudo que avaliou o papel dos odores exclusivamente em homens com enxaqueca. Houve um alto índice de enxaqueca relacionada a odores, sugerindo que a educação dos pacientes poderia alertar fatores dependentes do gênero do paciente, uma vez que diferentes fatores desencadeantes e de piora das crises tem sido relatados por homens e mulheres.