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Volume 16 Supplement 1

1st Joint ANIRCEF-SISC Congress

P051. Olfactory migrainous hallucinations: a typical aura manifestation?

Introduction

Although olfactory hallucination or phantosmia could occur in several neurological and non-neurological conditions, olfactory migrainous hallucination (OMH) is a rare and probably underestimated phenomenon, involving about 0.1% of migraine patients[1], and not considered among the migrainous aura manifestations according to the International Classification of Headache Disorders, 3th edition (ICHD-III beta version)[2]. Very few clinical studies on the topic have been published[3]; therefore, the clinical characterization of OMH is still lacking.

Materials and methods

We report the clinical features of OMH prospectively collected by a detailed and structured anamnesis obtained in 5 patients who spontaneously referred the presence of OMH associated to their headache attacks. Patients were subsequently followed with a diary for at least a year. Moreover, the efficacy of the prophylactic therapy, if suggested, has been recorded.

Results

Five patients (4 females, 1 male) presented with a history of migraine without aura (MO) (n=4) and with aura (MA) (n=1) associated with OHM. Mean age at the first evaluation and at headache onset was respectively 42.2 years (range 25-51) and 17.0 years (range 5-28), while OMH appeared at a mean age of 34.6 years (range 5-54). In 4 cases, a concomitant primary headache was diagnosed (MA, n=2; episodic tension-type headache, n=1; primary stabbing headache, n=1). Physical and neurological examinations, laboratory analyses, neuroimaging and EEG resulted unremarkable. OMH presented with an average frequency of once every 3 attacks. Onset and resolution of phantosmia were sudden in 3 cases and gradual in the remaining 2, with a mean duration of 10 min. The painful phase followed the disappearance of OMH in all the cases. The type of the perceived smell was invariably constant in 9 patients, while one patient reported different phantosmia for every different attack.

Conclusions

When properly asked, patients are able to describe in detail the features of their olfactory hallucination. Their characteristics fulfilled the ICHD-III beta criteria for the aura symptoms[2]: if these features should find confirmation in further prospective studies, OMH could be considered similarly to the typical aura manifestations and included among them in the MA diagnostic criteria in the appendix of the next ICHD.

Written informed consent to publication was obtained from the patient(s).

References

  1. 1.

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    Headache Classification Committee of the International Headache Society: The international classification of headache disorders: 3th edition (beta version). Cephalalgia. 2013, 33: 629-808.

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    Coleman ER, Brian MG, Robbins MS: Olfactory hallucinations in primary headache disorders: case series and literature review. Cephalalgia. 2011, 31: 1477-1489. 10.1177/0333102411423315.

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Correspondence to Matteo Bellamio.

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Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0), which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Bellamio, M., Mainardi, F., Toldo, G. et al. P051. Olfactory migrainous hallucinations: a typical aura manifestation?. J Headache Pain 16, A80 (2015). https://doi.org/10.1186/1129-2377-16-S1-A80

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Keywords

  • Migraine
  • Average Frequency
  • Migraine Patient
  • Headache Disorder
  • Migraine Without Aura
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