xRead - Olfactory Disorders (September 2023)

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INTERNATIONAL CONSENSUS ON OLFACTION

TABLE VII.15 Section evidence summary: Related to primary headache syndrome Year LOE Study design Study groups

Clinical end point Conclusions

Osmophobia is a specific clinical marker of migraine and can be used to distinguish migraine from other types of headache such as ETTH

Presence of

128 patients with MA 5 patients with MO 31 patients with ETTH 21 patients with MO and ETTH 7 patients with MA and ETTH One patient with MA and ETTH

Terrin

2020 1b

Systematic review and meta-analysis

et al 900

osmophobia before or during headache

Saisu

2011

3b

Prospective

Patients with MO Patients with MA HCs

Olfactory

Comparison between

et al 893

case-control

psychophysical tests (eg, UPSIT R and SS-TDI)

groups demonstrated osmophobia in 63% of MO and MA groups, with patients with MA having a worsened aversion than patients with MO to all scents 91% of migraine patients had normal smelling ability Migraine patients did not have a significant difference in olfactory ability during their attacks vs in between attacks, but they were more likely to have abnormal olfactory acuity compared with controls Comparison between groups demonstrated significantly decreased OBVs in patients with migraine (both MA and MO) compared with HCs There was no difference seen inOSL Amygdala activation during migraine in response to olfactory stimulation Higher regional cerebral blood flow in the left piriform cortex and anterosuperior temporal gyrus in migraineurs compared with controls during both olfactory and nonolfactory conditions

Whiting et al 908

2015

3b

Prospective

50 patients with migraine 50HCs

Olfactory

case-control

psychophysical tests (eg, UPSIT R and SS-TDI)

Aktürk

2019

3b

Prospective

Patients with MO Patients with MA HCs

OBV and OSL on MRI

et al 909

case-control

Stankewitz et al 886

2011

4

Case-control

20 migraine patients Sex- and age-matched HCs

Amygdala activation on fMRI

Demarquay et al 887

2008

4

Case-control

11 migraineurs with olfactory hypersensitivity

Regional cerebral blood flow

and 12 controls participated in a H(2)(15)O-PET study

ETTH = episodic tension-type headache; HC = healthy control; fMRI = functional magnetic resonance imaging; LOE = level of evidence; MA = migrainous headache with aura; MO = migrainous headache without aura; MRI = magnetic resonance imaging; OBV = olfactory bulb volume; OSL = olfactory sulcus length; PET = positron emission tomography; SS-TDI = Sniffin’ Sticks threshold, discrimination, identification combination; UPSIT R = University of Pennsylvania Smell Identification Test.