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Karsan N, Prabhakar P, Goadsby PJ. Extended Phenotyping of Migraine in Children: A Cross-Sectional Study in a Specialist Children's Headache Clinic. Pediatr Neurol 2024; 156:33-40. [PMID: 38718550 DOI: 10.1016/j.pediatrneurol.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/21/2024] [Accepted: 03/27/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND The pediatric migraine phenotype may exhibit differences to adults, leading to diagnostic challenges. We aimed to perform a cross-sectional systematic study to characterize the extended phenotype of pediatric migraine. METHODS New migraine patients presenting to the Children's Headache Clinic were included (n = 105). Data were collected via a detailed symptom questionnaire at the first clinical encounter and were analyzed using descriptive statistics, Cohen kappa (k), Spearman correlation (ρ), and Poisson and binomial logistic regression models within SPSS. RESULTS Patients were 65% female and aged five to 17 years (median 14, interquartile range [IQR] 11 to 15), with a mean disease duration of 4.7 years (S.D. 2.8). Monthly headache frequency was 1 to 30 days (median 30, IQR 12 to 30). Attack duration varied between 2 and 168 hours (median 12, IQR 5 to 72). The majority (81%) experienced bilateral headache. Premonitory symptoms (PS) were reported by 93% (range 0 to 7; mood change and tiredness most commonly), cranial autonomic symptoms (CAS) by 58% (range 0 to 6; pallor and lacrimation most commonly), and premonitory CAS by 23%. Vertigo (53%) and allodynia (16%) were present. The laterality of headache and CAS showed agreement (k = 0.5, P < 0.001). For every year of disease duration, 1.07 times more PS were reported (95% confidence interval [CI] 1.03 to 1.12, P < 0.001). The number of CAS (odds ratio 2.13, 95% CI 1.2 to 3.8, P = 0.01) significantly predicted allodynia. CONCLUSIONS Children display a more enriched PS phenotype with disease chronicity. CAS and allodynia may be markers of central sensitization with shared neurobiological mechanisms in the absence of peripheral nociceptor activation.
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Affiliation(s)
- Nazia Karsan
- Headache Group, NIHR King's Clinical Research Facility and SLaM Biomedical Research Centre, The Wolfson Sensory, Pain and Regeneration Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Neurology, Children's Headache Clinic, Great Ormond Street Hospital for Children, London, UK.
| | - Prab Prabhakar
- Department of Neurology, Children's Headache Clinic, Great Ormond Street Hospital for Children, London, UK
| | - Peter J Goadsby
- Headache Group, NIHR King's Clinical Research Facility and SLaM Biomedical Research Centre, The Wolfson Sensory, Pain and Regeneration Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Neurology, Children's Headache Clinic, Great Ormond Street Hospital for Children, London, UK; Department of Neurology, University of California, Los Angeles, CA
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Sciruicchio V, D'Agnano D, Clemente L, Rutigliano A, Laporta A, de Tommaso M. Clinical Correlates of Osmophobia in Primary Headaches: An Observational Study in Child Cohorts. J Clin Med 2023; 12:jcm12082939. [PMID: 37109275 PMCID: PMC10144088 DOI: 10.3390/jcm12082939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/31/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023] Open
Abstract
Primary headaches, especially migraines, have a significant impact on physical and mental health, as well as on the scholarly performance and quality of life of children and adolescents. Osmophobia could be a potential diagnostic marker of migraine diagnosis and disability. This multicenter observational cross-sectional study included 645 children, aged 8-15, with a diagnosis of primary headaches. We took into consideration the duration, intensity and frequency of headaches, pericranial tenderness, allodynia and osmophobia. In a subgroup of migraine children, we evaluated the migraine-related disability, Psychiatric Self-Administration Scales for Youths and Adolescents, and the Child Version of the Pain Catastrophizing Scale. Osmophobia was found to be present in 28.8% of individuals with primary headaches, with children suffering from migraines having the highest prevalence (35%). Migraine patients with osmophobia also showed a more severe clinical picture, with enhanced disability, anxiety, depression, pain catastrophizing, and allodynia symptoms (F Roy square 10.47 p < 0.001). The presence of osmophobia could help in identifying a clinical migraine phenotype coherent with an abnormal bio-behavioral allostatic model that is worthy of prospective observations and careful therapeutic management.
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Affiliation(s)
| | - Daniela D'Agnano
- Children Epilepsy and EEG Center, San Paolo Hospital, 70132 Bari, Italy
| | - Livio Clemente
- Neurophysiopathology Unit, DiBrain Department, Bari Aldo Moro University, 70121 Bari, Italy
| | | | - Anna Laporta
- Neurophysiopathology Unit, DiBrain Department, Bari Aldo Moro University, 70121 Bari, Italy
| | - Marina de Tommaso
- Neurophysiopathology Unit, DiBrain Department, Bari Aldo Moro University, 70121 Bari, Italy
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Courtney A, Holmes Z, Weston S. If your ears are burning we must be talking about red ear syndrome: A brief report. Australas J Dermatol 2022; 63:e244-e246. [PMID: 35510338 DOI: 10.1111/ajd.13862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/13/2022] [Accepted: 04/17/2022] [Indexed: 11/28/2022]
Abstract
Red Ear Syndrome is an uncommon disorder that can affect all age groups. It is frequently referred to Dermatology as it can present similarly to erythromelalgia. Although the exact pathophysiology is unknown, a common hypothesis suggests a shared pathophysiological background with migraine due to their well-known association. Currently, there are no established treatment guidelines. Delays in accurate diagnosis and commencing optimal treatment can significantly negatively impact on a patients quality of life. We discuss the clinical presentation and response to treatment of a case of Red Ear Syndrome in an 8-year-old boy.
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Affiliation(s)
- Ashling Courtney
- Dermatology Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Zack Holmes
- Dermatology Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Stephanie Weston
- Dermatology Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
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4
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Patel ZM, Holbrook EH, Turner JH, Adappa ND, Albers MW, Altundag A, Appenzeller S, Costanzo RM, Croy I, Davis GE, Dehgani-Mobaraki P, Doty RL, Duffy VB, Goldstein BJ, Gudis DA, Haehner A, Higgins TS, Hopkins C, Huart C, Hummel T, Jitaroon K, Kern RC, Khanwalkar AR, Kobayashi M, Kondo K, Lane AP, Lechner M, Leopold DA, Levy JM, Marmura MJ, Mclelland L, Miwa T, Moberg PJ, Mueller CA, Nigwekar SU, O'Brien EK, Paunescu TG, Pellegrino R, Philpott C, Pinto JM, Reiter ER, Roalf DR, Rowan NR, Schlosser RJ, Schwob J, Seiden AM, Smith TL, Soler ZM, Sowerby L, Tan BK, Thamboo A, Wrobel B, Yan CH. International consensus statement on allergy and rhinology: Olfaction. Int Forum Allergy Rhinol 2022; 12:327-680. [PMID: 35373533 DOI: 10.1002/alr.22929] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/01/2021] [Accepted: 11/19/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The literature regarding clinical olfaction, olfactory loss, and olfactory dysfunction has expanded rapidly over the past two decades, with an exponential rise in the past year. There is substantial variability in the quality of this literature and a need to consolidate and critically review the evidence. It is with that aim that we have gathered experts from around the world to produce this International Consensus on Allergy and Rhinology: Olfaction (ICAR:O). METHODS Using previously described methodology, specific topics were developed relating to olfaction. Each topic was assigned a literature review, evidence-based review, or evidence-based review with recommendations format as dictated by available evidence and scope within the ICAR:O document. Following iterative reviews of each topic, the ICAR:O document was integrated and reviewed by all authors for final consensus. RESULTS The ICAR:O document reviews nearly 100 separate topics within the realm of olfaction, including diagnosis, epidemiology, disease burden, diagnosis, testing, etiology, treatment, and associated pathologies. CONCLUSION This critical review of the existing clinical olfaction literature provides much needed insight and clarity into the evaluation, diagnosis, and treatment of patients with olfactory dysfunction, while also clearly delineating gaps in our knowledge and evidence base that we should investigate further.
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Affiliation(s)
- Zara M Patel
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Eric H Holbrook
- Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Justin H Turner
- Otolaryngology, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Nithin D Adappa
- Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark W Albers
- Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aytug Altundag
- Otolaryngology, Biruni University School of Medicine, İstanbul, Turkey
| | - Simone Appenzeller
- Rheumatology, School of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Richard M Costanzo
- Physiology and Biophysics and Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Ilona Croy
- Psychology and Psychosomatic Medicine, TU Dresden, Dresden, Germany
| | - Greg E Davis
- Otolaryngology, Proliance Surgeons, Seattle and Puyallup, Washington, USA
| | - Puya Dehgani-Mobaraki
- Associazione Naso Sano, Umbria Regional Registry of Volunteer Activities, Corciano, Italy
| | - Richard L Doty
- Smell and Taste Center, Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Valerie B Duffy
- Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | | | - David A Gudis
- Otolaryngology, Columbia University Irving Medical Center, New York, USA
| | - Antje Haehner
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | - Thomas S Higgins
- Otolaryngology, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Claire Hopkins
- Otolaryngology, Guy's and St. Thomas' Hospitals, London Bridge Hospital, London, UK
| | - Caroline Huart
- Otorhinolaryngology, Cliniques universitaires Saint-Luc, Institute of Neuroscience, Université catholgique de Louvain, Brussels, Belgium
| | - Thomas Hummel
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | | | - Robert C Kern
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashoke R Khanwalkar
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Masayoshi Kobayashi
- Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Kenji Kondo
- Otolaryngology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Andrew P Lane
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matt Lechner
- Otolaryngology, Barts Health and University College London, London, UK
| | - Donald A Leopold
- Otolaryngology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Joshua M Levy
- Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael J Marmura
- Neurology Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lisha Mclelland
- Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Takaki Miwa
- Otolaryngology, Kanazawa Medical University, Ishikawa, Japan
| | - Paul J Moberg
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Sagar U Nigwekar
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erin K O'Brien
- Otolaryngology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Teodor G Paunescu
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Carl Philpott
- Otolaryngology, University of East Anglia, Norwich, UK
| | - Jayant M Pinto
- Otolaryngology, University of Chicago, Chicago, Illinois, USA
| | - Evan R Reiter
- Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - David R Roalf
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nicholas R Rowan
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rodney J Schlosser
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - James Schwob
- Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Allen M Seiden
- Otolaryngology, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Timothy L Smith
- Otolaryngology, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Zachary M Soler
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - Leigh Sowerby
- Otolaryngology, University of Western Ontario, London, Ontario, Canada
| | - Bruce K Tan
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrew Thamboo
- Otolaryngology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bozena Wrobel
- Otolaryngology, Keck School of Medicine, USC, Los Angeles, California, USA
| | - Carol H Yan
- Otolaryngology, School of Medicine, UCSD, La Jolla, California, USA
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Premonitory and Accompanying Symptoms in Childhood Migraine. Curr Pain Headache Rep 2022; 26:151-163. [DOI: 10.1007/s11916-022-01015-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 11/03/2022]
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Mínguez-Olaondo A, Quintas S, Morollón Sánchez-Mateos N, López-Bravo A, Vila-Pueyo M, Grozeva V, Belvís R, Santos-Lasaosa S, Irimia P. Cutaneous Allodynia in Migraine: A Narrative Review. Front Neurol 2022; 12:831035. [PMID: 35153995 PMCID: PMC8830422 DOI: 10.3389/fneur.2021.831035] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/29/2021] [Indexed: 11/28/2022] Open
Abstract
Objective In the present work, we conduct a narrative review of the most relevant literature on cutaneous allodynia (CA) in migraine. Background CA is regarded as the perception of pain in response to non-noxious skin stimulation. The number of research studies relating to CA and migraine has increased strikingly over the last few decades. Therefore, the clinician treating migraine patients must recognize this common symptom and have up-to-date knowledge of its importance from the pathophysiological, diagnostic, prognostic and therapeutic point of view. Methods We performed a comprehensive narrative review to analyze existing literature regarding CA in migraine, with a special focus on epidemiology, pathophysiology, assessment methods, risk for chronification, diagnosis and management. PubMed and the Cochrane databases were used for the literature search. Results The prevalence of CA in patients with migraine is approximately 60%. The mechanisms underlying CA in migraine are not completely clarified but include a sensitization phenomenon at different levels of the trigemino-talamo-cortical nociceptive pathway and dysfunction of brainstem and cortical areas that modulate thalamocortical inputs. The gold standard for the assessment of CA is quantitative sensory testing (QST), but the validated Allodynia 12-item questionnaire is preferred in clinical setting. The presence of CA is associated with an increased risk of migraine chronification and has therapeutic implications. Conclusions CA is a marker of central sensitization in patients with migraine that has been associated with an increased risk of chronification and may influence therapeutic decisions.
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Affiliation(s)
- Ane Mínguez-Olaondo
- Neurology Department, Hospital Universitario Donostia, San Sebastián, Spain
- Athenea Neuroclinics, Policlínica Guipúzcoa, Grupo Quirón Salud Donostia, San Sebastián, Spain
- Neuroscience Area, Biodonostia Health Institute, Donostia, Spain
- Medicine Faculty, University of Deusto, Bilbao, Spain
- Clínica Universidad de Navarra, Pamplona, Spain
| | - Sonia Quintas
- Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Alba López-Bravo
- Hospital Reina Sofía, Tudela, Spain
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Marta Vila-Pueyo
- Headache and Neurological Pain Research Group, Department of Medicine, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Robert Belvís
- Headache and Neuralgia Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Sonia Santos-Lasaosa
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Pablo Irimia
- Clínica Universidad de Navarra, Pamplona, Spain
- *Correspondence: Pablo Irimia
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7
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Borri J, Silva Junior HMD. Red Ear Syndrome and migraine: case report and review of this peculiar association. HEADACHE MEDICINE 2022. [DOI: 10.48208/headachemed.2021.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Introduction: The "Red Ear Syndrome" (RES) is a rare condition (about 100 cases were published in 25 years). It is characterized by episodes of hyperemia of the ear associated with burning pain. Although the association of this syndrome and primary headaches is contemplated in literature, its etiology and treatments are still poorly defined.
The aim of this paper is to report a case of RES related to migraine and possible pathophysiologic mechanisms.
Case Report: A 31-year-old woman presented with stabbing pain and marked erythema and edema of the right ear accompanied by burning and local hyperhidrosis. These attacks lasted 2 hours on average, and either occurred spontaneously or were associated with migraine without aura. The only means of relief during the attacks was cooling the local with ice.
Extensive laboratory-chemical, microbiological, ear-nose-throat, clinical and neurological examinations, magnetic resonance of the brain and cervical spine were unremarkable.
Conclusion: Uncertainty about the etiology of this syndrome is an obstacle to treatment. The frequent relationship between RES and migraine suggests that is necessary to investigate the syndrome in migraineurs. Furthermore, new reports about this disorder are important to increase the knowledge of physicians, to reduce the delay in diagnosis and suffering of patients.
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8
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Delussi M, Laporta A, Fraccalvieri I, de Tommaso M. Osmophobia in primary headache patients: associated symptoms and response to preventive treatments. J Headache Pain 2021; 22:109. [PMID: 34537019 PMCID: PMC8449918 DOI: 10.1186/s10194-021-01327-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/07/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Osmophobia, is common among primary headaches, with prevalence of migraine. The study aimed to evaluate prevalence and clinical characteristics of patients with osmophobia in a cohort of primary headache patients selected at a tertiary headache center. The second aim was to verify the possible predicting role of osmophobia in preventive treatment response in a sub cohort of migraine patients. METHODS This was an observational retrospective cohort study based on data collected in a tertiary headache center. We selected patients aged 18-65 years, diagnosed as migraine without aura (MO), migraine with aura (MA) or Chronic Migraine (CM), Tension-Type Headache (TTH); and Cluster Headache (CH). We also selected a sub-cohort of migraine patients who were prescribed preventive treatment, according to Italian Guidelines, visited after 3 months follow up. Patients were considered osmophobic, if reported this symptom in at least the 20% of headache episodes. Other considered variables were: headache frequeny, the migraine disability assessment (MIDAS), Allodynia Symptom Checklist, Self-rating Depression scale, Self-rating Anxiety scale, Pain intensity evaluated by Numerical Rating Scale-NRS- form 0 to 10. RESULTS The 37,9% of patients reported osmophobia (444 patients with osmophobia, 726 without osmophobia). Osmophobia prevailed in patients with the different migraine subtypes, and was absent in patients with episodic tension type headache and cluster headache (chi square 68.7 DF 7 p < 0.0001). Headache patients with osmophobia, presented with longer hedache duration (F 4.91 p 0.027; more severe anxiety (F 7.56 0.007), depression (F 5.3 p 0.019), allodynia (F 6 p 0.014), headache intensity (F 8.67 p 0.003). Tension type headache patients with osmophobia (n° 21), presented with more frequent headache and anxiety. A total of 711 migraine patients was visited after 3 months treatment. The change of main migraine features was similar between patients with and without osmophobia. CONCLUSIONS While the present study confirmed prevalence of osmophobia in migraine patients, it also indicated its presence among chronic tension type headache cases, marking those with chronic headache and anxiety. Osmophobia was associated to symptoms of central sensitization, as allodynia. It was not relevant to predict migraine evolution after first line preventive approach.
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Affiliation(s)
- Marianna Delussi
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Aldo Moro University, Bari, Italy
| | - Anna Laporta
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Aldo Moro University, Bari, Italy
| | - Ilaria Fraccalvieri
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Aldo Moro University, Bari, Italy
| | - Marina de Tommaso
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Aldo Moro University, Bari, Italy.
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Albanês Oliveira Bernardo A, Lys Medeiros F, Sampaio Rocha‐Filho PA. Osmophobia and Odor‐Triggered Headaches in Children and Adolescents: Prevalence, Associated Factors, and Importance in the Diagnosis of Migraine. Headache 2020; 60:954-966. [DOI: 10.1111/head.13806] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 01/24/2023]
Affiliation(s)
- Albérico Albanês Oliveira Bernardo
- Postgraduate Program in Neuropsychiatry and Behavioral Sciences Federal University of Pernambuco Recife Brazil
- Pelopidas Silveira Hospital Recife Brazil
| | - Fabiola Lys Medeiros
- Children’s Headache Clinic Oswaldo Cruz University Hospital University of Pernambuco Recife Brazil
| | - Pedro Augusto Sampaio Rocha‐Filho
- Department of Neuropsychiatry Federal University of Pernambuco Recife Brazil
- Headache Clinic Oswaldo Cruz University Hospital University of Pernambuco Recife Brazil
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10
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Patel I, Desai D, Desai S. Red Ear Syndrome: Case Series and Review of a Less Recognized Headache Disorder. Ann Indian Acad Neurol 2020; 23:715-718. [PMID: 33623284 PMCID: PMC7887477 DOI: 10.4103/aian.aian_1_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 01/21/2020] [Accepted: 02/08/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ishani Patel
- Intern Doctor, Shree Krishna Hospital, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
| | - Devangi Desai
- Department of Medicine, Shree Krishna Hospital, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
| | - Soaham Desai
- Department of Neurology, Shree Krishna Hospital, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India,Address for correspondence: Dr. Soaham Desai, Department of Neurology, Shree Krishna Hospital, Pramukhswami Medical College, Karamsad, Anand, Gujarat - 388 325, India. E-mail:
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11
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Terrin A, Mainardi F, Lisotto C, Mampreso E, Fuccaro M, Maggioni F, Zanchin G. A prospective study on osmophobia in migraine versus tension-type headache in a large series of attacks. Cephalalgia 2019; 40:337-346. [DOI: 10.1177/0333102419877661] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background In literature, osmophobia is reported as a specific migrainous symptom with a prevalence of up to 95%. Despite the International Classification of Headache Disorders 2nd edition proposal of including osmophobia among accompanying symptoms, it was no longer mentioned in the ICHD 3rd edition. Methods We conducted a prospective study on 193 patients suffering from migraine without aura, migraine with aura, episodic tension-type headache or a combination of these. After a retrospective interview, each patient was asked to describe in detail osmophobia, when present, in the following four headache attacks. Results In all, 45.7% of migraine without aura attacks were associated with osmophobia, 67.2% of migraineurs reported osmophobia in at least a quarter of the attacks. No episodic tension-type headache attack was associated with osmophobia. It was associated with photophobia or phonophobia in 4.3% of migraine without aura attacks, and it was the only accompanying symptom in 4.7% of migraine without aura attacks. The inclusion of osmophobia in the ICHD-3 diagnostic criteria would enable a 9.0% increased diagnostic sensitivity. Conclusion Osmophobia is a specific clinical marker of migraine, easy to ascertain and able to disentangle the sometimes challenging differential diagnosis between migraine without aura and episodic tension-type headache. We recommend its inclusion among the diagnostic criteria for migraine as it increases sensitivity, showing absolute specificity.
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Affiliation(s)
- Alberto Terrin
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Federico Mainardi
- Headache Centre, Neurological Division, SS. Giovanni e Paolo Hospital, Venezia, Italy
| | - Carlo Lisotto
- Headache Centre, Department of Neurology, Azienda Sanitaria n. 5 Friuli Occidentale, Pordenone, Italy
| | - Edoardo Mampreso
- Headache Centre, Neurology – Euganea – Padova Health Unit, Padova, Italy
| | | | | | - Giorgio Zanchin
- Department of Neuroscience, University of Padova, Padova, Italy
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Chalmer MA, Hansen TF, Olesen J. Nosographic analysis of osmophobia and field testing of diagnostic criteria including osmophobia. Cephalalgia 2018; 39:38-43. [PMID: 29665696 DOI: 10.1177/0333102418771375] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Osmophobia has been suggested as an additional symptom of migraine without aura, and a high prevalence of osmophobia of up to 50% has been reported in the literature. We conducted a nosographic study of osmophobia in all migraineurs and tension-type headache patients and a field testing of suggested diagnostic criteria of osmophobia, presented in the appendix of the second edition of The International Classification of Headache Disorders and suggested by Silva-Néto et al. and Wang et al ., in migraine without aura and tension-type headache patients (n = 1934). MATERIALS AND METHODS Each patient received a validated semi-structured interview. All subjects fulfilled the diagnostic criteria of the second edition of The International Classification of Headache Disorders for migraine or tension-type headache. Statistical analyses were performed using statistical software R. The statistical R package "Caret" was used to construct a confusion matrix and retrieve sensitivity, which is defined as the suggested criteria's ability to correctly diagnose migraine without aura patients, and specificity, defined as the suggested criteria's ability to not wrongly diagnose tension-type headache patients. RESULTS Osmophobia was present in 33.5% of patients with migraine with aura, in 36.0% of patients with migraine without aura, and in 1.2% of patients with tension-type headache. All migraineurs with osmophobia also fulfilled the current criteria for migraine by having nausea or photophobia and phonophobia. The appendix criteria had a sensitivity of 0.96 and a specificity of 0.99 for migraine without aura, and a sensitivity of 0.65 and a specificity of 0.99 for probable migraine without aura. Both the criteria by Silva-Néto et al. and Wang et al. had a sensitivity of 0.98 and a specificity of 0.99 for migraine without aura, and a sensitivity of 0.66 and a specificity of 0.99 for probable migraine without aura. DISCUSSION This study demonstrates the remarkable specificity of osmophobia. The criteria by Silva-Néto et al. and Wang et al. both had a higher sensitivity than the appendix criteria for migraine without aura; all three criteria had a low sensitivity for probable migraine without aura. However, neither the appendix criteria nor the criteria by Silva-Néto et al. or Wang et al. added any extra patients that would not have been diagnosed by the current diagnostic criteria for migraine. Osmophobia is a valuable symptom that may be useful to differentiate between migraine without aura and tension-type headache in difficult clinical cases. CONCLUSION Our results do not suggest that alterations of the current diagnostic criteria for migraine without aura are needed.
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Affiliation(s)
- Mona Ameri Chalmer
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Glostrup, Denmark
| | - Thomas Folkmann Hansen
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Glostrup, Denmark
| | - Jes Olesen
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Glostrup, Denmark
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Abstract
OBJECTIVE Allodynia reflects the clinical correlate of central sensitization, but it is usually neglected in clinical headache management. We aimed to report the prevalence and previously unnoticed associations of allodynia in migraineurs by a nationwide face-to-face questionnaire-based study by physicians. METHODS A total of 5323 households were examined for headache according to the diagnostic criteria of International Classification of Headache Disorders-II. Detailed headache features, premonitory signs, demographics, socio-economic status, and hormonal status of female individuals were analyzed with regard to the presence of allodynia in patients with definite migraine. RESULTS Allodynia was present in 61.1% of migraineurs in the general population of Turkey. The duration and severity of attacks (P<0.0001), photophobia (P=0.001), phonophobia, and also osmophobia (P<0.0001), as well as premonitory signs (P=0.018), showed significant associations with allodynia. Migraineurs with aura or family history of migraine more often reported allodynia in comparison with those without (P=0.001 and 0.028, respectively). Allodynic migraineurs had a higher rate of physician consults and high levels on the Migraine Disability Assessment questionnaire, reflecting increased burden of headache. Furthermore, migraineurs with allodynia had high probability of attacks close to menses. Migraine improved during pregnancy, but it worsened after menopause or during oral contraceptive use in individuals experiencing allodynia when compared with those without allodynia. DISCUSSION The duration, severity, and disability of migraine attacks, photophobia, phonophobia, and osmophobia, as well as premonitory signs, showed significant associations with allodynia in the general population. Moreover, migraineurs with aura or family history of migraine more often reported allodynia, and allodynic migraneurs were more sensitive to hormonal changes. Allodynia, which seems to indicate higher tendency to central sensitization, should be implemented in daily headache practice to predict the prognosis and high levels of migraineous involvement.
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Zanchin G, Dainese F, Trucco M, Mainardi F, Mampreso E, Maggioni F. Osmophobia in Migraine and Tension-Type Headache and Its Clinical Features in Patients With Migraine. Cephalalgia 2016; 27:1061-8. [PMID: 17681021 DOI: 10.1111/j.1468-2982.2007.01421.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Intolerance to smell is often reported by migraine patients. This study evaluates osmophobia in connection with the diagnosis of migraine and episodic tension-type headache (ETTH). The characteristics of this symptom are also investigated. We recruited from our Headache Centre 1005 patients (772 female, 233 male; age 37 ± 11 years), of whom 677 were migraine without aura (MoA), 130 migraine with aura (MA) and 198 TTH. Patients with two or more forms of primary headache were excluded. Among migraine patients, 43.9% with MoA and 38.5% with MA reported osmophobia during the attacks; none of the 198 TTH patients suffered this symptom. Most frequently offending odours were scents (63.9%), food (55.2%) and cigarette smoke (54.8%). Osmophobia appears structurally integrated into the migraine history of the patient. It seems to be a peculiar symptom favouring the diagnosis of migraine (MoA and MA) in the differential diagnosis with ETTH.
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Affiliation(s)
- G Zanchin
- Headache Centre, Department of Neurosciences, University of Padua, Padua, Italy.
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15
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Zanchin G, Fuccaro M, Battistella P, Ermani M, Mainardi F, Maggioni F. A lost track in ICHD 3 beta: A comprehensive review on osmophobia. Cephalalgia 2016; 38:340-352. [DOI: 10.1177/0333102416678390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Osmophobia (Os) has been reported to be much more prevalent in migraine (M) than in other primary headaches, and its high specificity in the differential diagnosis between M and tension-type headache (TTH) has been reported. Os was included in the ICHD II Appendix as a diagnostic criterion of M. It disappeared in ICHD-3 beta. To understand this choice, we reviewed the literature after 2004. Methods This was a systematic review. We searched in PubMed, MEDLINE and Cochrane library for “osmophobia”, “odour/odorphobia AND headache”, “odour/odor hypersensitivity AND headache” and “olfactory hypersensitivity AND headache”. Results 112 papers cited Os as an accompanying symptom of headache; 16 focused on Os in M diagnosis. With the data from 40 articles, we calculated the pooled prevalence of Os in 14,360 patients (2281 pediatric) affected by M (n = 12,496) and TTH (n = 1864). In M, the prevalence was 48.5% (CI 95% 41.4 to 55.8%) in adults and 23.4% (CI 95% 15.7 to 33.4%) in pediatric patients; in TTH, the prevalence was 8.9% (CI 95% 4.6 to 13.5%) in adults and 7.9% (CI 95% 3.3 to 18.1%) in pediatric patients. Ten of these papers allowed us to calculate the sensibility and specificity of Os in differential diagnosis between M and TTH. In adults, the value of specificity was 94.1% (CI 95% 88.9 to 96.9%), and sensitivity was 51.4% (CI 95% 38.4 to 64.2%). In pediatric patients, specificity was 92.0% (CI 95% 81.9 to 96.7%), and sensitivity was 22.1% (CI 95% 10.1 to 41.8%). Conclusion The literature endorses the inclusion of Os among M diagnostic criteria. On this ground, the decision to remove Os from ICHD 3 beta appears unjustified and a revision of this choice is recommended.
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Affiliation(s)
- Giorgio Zanchin
- Interdepartmental Headache Centre, School of Medicine, University of Padua, Padua, Italy
| | - Matteo Fuccaro
- Interdepartmental Headache Centre, School of Medicine, University of Padua, Padua, Italy
| | | | - Mario Ermani
- Interdepartmental Headache Centre, School of Medicine, University of Padua, Padua, Italy
| | - Federico Mainardi
- Headache Centre, Neurological Division, SS Giovanni e Paolo Hospital, Venice, Italy
| | - Ferdinando Maggioni
- Interdepartmental Headache Centre, School of Medicine, University of Padua, Padua, Italy
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Raieli V, Pitino R, Giordano G, Spitalieri C, Consolo F, Puma D, Santangelo G, Vanadia F, D'Amelio M. Migraine in a pediatric population: a clinical study in children younger than 7 years of age. Dev Med Child Neurol 2015; 57:585-8. [PMID: 25586426 DOI: 10.1111/dmcn.12679] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2014] [Indexed: 01/17/2023]
Abstract
AIM Migraines in children younger than 7 years of age have received limited attention in the published literature. The aim of this study is to describe the characteristics of migraine phenotypes in children younger than 7 years, and to compare them with migraines in children older than 7 years of age. METHOD We reviewed all standard clinical files, collected over 4 years, related to children with a diagnosis of primary headache. We included all children younger than 7 years diagnosed with migraine in our study. RESULTS A total of 374 children (188 males, 186 females) were affected by migraine with/without aura: 40 of these patients (10.7%; 20 males, 20 females; mean age 5y 7mo, SD 1y 2mo) where younger than 7 years old. The frequencies of the main migraine features in the younger age group were similar to those of children older than 7 years, with the exception of a shorter duration of migraine and reduced frequency of attacks. INTERPRETATION In children younger than 7 years of age, the clinical phenotype of migraine is similar to that seen in older children. We propose that there is a general genetic migraine susceptibility that, in the presence of activating environmental factors, may induce typical attacks of migraine in individuals already predisposed to migraine attacks. Therefore, different modules induce different clinical features within the different age groups, but there is no difference in the frequencies of clinical phenotypes between the two age groups.
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Affiliation(s)
- Vincenzo Raieli
- Child Neuropsychiatry Unit, Di Cristina Hospital ARNAS Civico, Palermo, Italy
| | - Renata Pitino
- Child Neuropsychiatry School, University of Palermo, Palermo, Italy
| | | | | | - Flavia Consolo
- Child Neuropsychiatry Unit, Di Cristina Hospital ARNAS Civico, Palermo, Italy
| | - Domenico Puma
- Child Neuropsychiatry Unit, Di Cristina Hospital ARNAS Civico, Palermo, Italy
| | - Giuseppe Santangelo
- Child Neuropsychiatry Unit, Di Cristina Hospital ARNAS Civico, Palermo, Italy
| | - Francesca Vanadia
- Child Neuropsychiatry Unit, Di Cristina Hospital ARNAS Civico, Palermo, Italy
| | - Marco D'Amelio
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
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Rota E, Iafelice I, Morelli N, Ratti G, Guidetti D. Tuberculous leptomeningitis mimicking a migrainous status with osmophobia: a case report. Acta Neurol Belg 2015; 115:177-9. [PMID: 24996870 DOI: 10.1007/s13760-014-0326-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 06/16/2014] [Indexed: 11/26/2022]
Affiliation(s)
- E Rota
- Department of Neurology, Guglielmo da Saliceto Hospital, Via Taverna 49, 29121, Piacenza, Italy,
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Raieli V, Trapolino D, Giordano G, Spitaleri C, Consolo F, Santangelo G, Buffa D, Vanadia F, D'Amelio M. Juvenile Migraine and Allodynia: Results of a Retrospective Study. Headache 2015; 55:413-8. [DOI: 10.1111/head.12530] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Vincenzo Raieli
- Child Neuropsychiatry Unit; Di Cristina Hospital; ARNAS CIVICO; Palermo Italy
| | - Davide Trapolino
- Child Neuropsychiatry School; University of Palermo; Palermo Italy
| | | | - Chiara Spitaleri
- Child Neuropsychiatry School; University of Palermo; Palermo Italy
| | - Flavia Consolo
- Child Neuropsychiatry Unit; Di Cristina Hospital; ARNAS CIVICO; Palermo Italy
| | - Giuseppe Santangelo
- Child Neuropsychiatry Unit; Di Cristina Hospital; ARNAS CIVICO; Palermo Italy
| | - Daniela Buffa
- Child Neuropsychiatry Unit; Di Cristina Hospital; ARNAS CIVICO; Palermo Italy
| | - Francesca Vanadia
- Child Neuropsychiatry Unit; Di Cristina Hospital; ARNAS CIVICO; Palermo Italy
| | - Marco D'Amelio
- Department of Experimental Biomedicine and Clinical Neurosciences; University of Palermo; Palermo Italy
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Moitri MO, Banglawala SM, Archibald J. Red ear syndrome: literature review and a pediatric case report. Int J Pediatr Otorhinolaryngol 2015; 79:281-5. [PMID: 25583087 DOI: 10.1016/j.ijporl.2014.12.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 11/25/2022]
Abstract
Red ear syndrome (RES) is characterized by recurrent unilateral or bilateral painful attacks of the external ear, accompanied by ear redness, burning, or warmth. Proposed etiologies of this rare condition include dysregulation of sympathetic outflow, upper cervical pathology, glossopharyngeal and trigeminal neuralgia, TMJ dysfunction, thalamic syndrome, and primary headache syndromes. Idiopathic cases also exist in the literature. Pediatric cases are particularly rare and more commonly associated with migraine. Given the various potential etiologies, no single treatment is effective in all cases. This paper summarizes the current understanding and management of RES, and describes a case of idiopathic pediatric RES.
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Affiliation(s)
- Misha O Moitri
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5.
| | - Sarfaraz M Banglawala
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5
| | - Jason Archibald
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5
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20
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Chan CC, Ghosh S. Red ear syndrome precipitated by a dietary trigger: a case report. J Med Case Rep 2014; 8:338. [PMID: 25303997 PMCID: PMC4196464 DOI: 10.1186/1752-1947-8-338] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 08/20/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction Red ear syndrome is a rare condition characterized by episodic attacks of erythema of the ear accompanied by burning ear pain. Symptoms are brought on by touch, exertion, heat or cold, stress, neck movements and washing or brushing of hair. Diagnosis and treatment of this condition are challenging. The case we report here involves a woman whose symptoms were brought on by a dietary trigger: orange juice as well as stress, causing significant physical and psychological morbidity. Avoidance of triggers resulted in symptomatic improvement. Case presentation A 22-year-old Caucasian woman who was a student presented twice to our department with evolving symptoms, the first time with hyperacusis (abnormal sound sensitivity arising from within the auditory system to sounds of moderate volume), intermittent right tinnitus and subjective hearing difficulties. She presented five years later with highly distressing episodes of erythematous ears, which were associated with burning pain around the ear and temporal areas, and intolerance to noise. After keeping a symptom diary, she identified orange juice and stress as triggers of her symptoms. No local head and neck pathology was present. Investigations and imaging were negative. Avoidance of triggers led to great symptomatic improvement. To the best of our knowledge, dietary triggers have not previously been reported as a trigger for this syndrome. This case shows a direct temporal link to a dietary trigger and supports a primary pathogenesis. Recognition and management of primary headache disorder and simple dietary and lifestyle changes brought about symptomatic relief. Conclusion Red ear syndrome is a little-known clinical syndrome of unknown etiology and management. To the best of our knowledge, our present case report is the first to describe primary red ear syndrome triggered by orange juice. Clinical benefit derived from avoidance of this trigger, which is already known to precipitate migraines, gives some insight into the pathogenesis of red ear syndrome.
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Affiliation(s)
- Chung Chi Chan
- Department of Audiovestibular Medicine, St Ann's Hospital, St Ann's Road, London N15 3TH, UK.
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Silva-Néto RP, Peres MFP, Valença MM. Accuracy of osmophobia in the differential diagnosis between migraine and tension-type headache. J Neurol Sci 2014; 339:118-22. [DOI: 10.1016/j.jns.2014.01.040] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/10/2014] [Accepted: 01/29/2014] [Indexed: 11/15/2022]
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Affiliation(s)
- Luiz P. Queiroz
- Department of Neurology; Universidade Federal de Santa Catarina; Florianópolis Brazil
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De Carlo D, Toldo I, Dal Zotto L, Perissinotto E, Sartori S, Gatta M, Balottin U, Mazzotta G, Moscato D, Raieli V, Rossi LN, Sangermani R, Soriani S, Termine C, Tozzi E, Vecchio A, Zanchin G, Battistella PA. Osmophobia as an early marker of migraine: A follow-up study in juvenile patients. Cephalalgia 2012; 32:401-6. [DOI: 10.1177/0333102412438975] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Osmophobia is frequent in children with migraine (20–35%) but can also occur in up to 14% of cases with tension-type headache (TTH). So far, the prognostic role of this symptom in children with primary headaches has never been evaluated. Methods: A longitudinal prospective study was conducted on 90 young patients with TTH (37 with osmophobia, 53 without osmophobia). We evaluated whether osmophobia could predict the diagnosis transformation from TTH to migraine after a 3-year follow-up. Results and Discussion: In our cases the rate of diagnosis change was significantly greater in cases with osmophobia (62%) than in those without (23%). Osmophobia persisted at a 3-year follow-up in the majority of our cases (85%) and it was found to be one of the major predictors for the development of migraine; other predictors of evolution to migraine were phonophobia, a probable rather than certain diagnosis of TTH and olfactory triggers (p < 0.05). Conclusion: Our data confirm that osmophobia has an important diagnostic and prognostic role in children with primary headaches and should be systematically investigated at diagnosis and during follow-up.
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Affiliation(s)
- Debora De Carlo
- Juvenile Headache Centre, Department of Paediatrics University of Padua, Italy
| | - Irene Toldo
- Juvenile Headache Centre, Department of Paediatrics University of Padua, Italy
| | - Lara Dal Zotto
- Juvenile Headache Centre, Department of Paediatrics University of Padua, Italy
| | - Egle Perissinotto
- Department of Environmental Medicine and Public Health, University of Padua, Italy
| | - Stefano Sartori
- Juvenile Headache Centre, Department of Paediatrics University of Padua, Italy
| | - Michela Gatta
- Juvenile Headache Centre, Department of Paediatrics University of Padua, Italy
| | - Umberto Balottin
- Child Neuropsychiatry Unit, “IRCCS Neurological Institute C. Mondino Foundation”, University of Pavia, Italy
| | | | | | - Vincenzo Raieli
- Child Neuropsychiatry Division “G.F. Ingrassia” Hospital, AUSL n°6, Palermo, Italy
| | | | | | - Stefano Soriani
- Department of Clinical and Experimental Medicine, Paediatrics, University of Ferrara, Italy
| | - Cristiano Termine
- Child Neuropsychiatry Unit, Department of Clinical and Biological Sciences Varese, Italy
| | - Elisabetta Tozzi
- Department of Experimental Medicine, University of L’Aquila, Italy
| | - Angelo Vecchio
- Child Neuropsychiatry Division, University of Palermo, Italy
| | - Giorgio Zanchin
- Headache Centre, Department of Neurosciences, University of Padua Medical School, Padua, Italy
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Eismann R, Gaul C, Wohlrab J, Marsch WC, Fiedler E. Red Ear Syndrome: Case Report and Review of the Literature. Dermatology 2011; 223:196-9. [DOI: 10.1159/000331578] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 07/19/2011] [Indexed: 11/19/2022] Open
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Raieli V, Compagno A, Brighina F, La Franca G, Puma D, Ragusa D, Savettieri G, D'Amelio M. Prevalence of red ear syndrome in juvenile primary headaches. Cephalalgia 2010; 31:597-602. [PMID: 21123628 DOI: 10.1177/0333102410388437] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous studies have suggested a relationship between 'red ear syndrome' (RES) and pediatric migraine. Aims of this study were (i) to assess the frequency, specificity and sensitivity of RES in a population of pediatric migraineurs and (ii) to establish the pathophysiological mechanisms of RES associated with migraine. METHODS AND RESULTS A total of 226 children suffering from headache (aged 4-17 years) were enrolled. One hundred and seventy-two (76.4%) were affected by migraine, the remaining 54 (23.6%) by other primary headaches. RES was followed significantly more frequently by migraine (23.3%; p < .0001), and was characterized by high specificity and positive predictive value (96.3 and 95.3%, respectively). According to the univariate statistical analysis, RES showed a statistically significant association with male gender, throbbing quality of the pain, vomiting and phonophobia. It was confirmed by a multivariate stepwise logistic regression model only for the throbbing quality of the pain, vomiting and male gender. CONCLUSIONS Our study showed that (i) in children, RES is a highly specific sign for migraine. In addition, the evidence of an association of RES with some migraine features partially provoked by the parasympathetic system supports the hypothesis of a shared pathophysiological background (e.g. via the activation of the trigeminal-autonomic reflex).
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Affiliation(s)
- V Raieli
- U.O. di Neuropsichiatria Infantile, P.O. G. Di Cristina, Palermo, Italy.
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Abstract
Aims: 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). Methods: 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%). Results: 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. Conclusions: 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.
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Corletto E, Dal Zotto L, Resos A, Tripoli E, Zanchin G, Bulfoni C, Battistella PA. Osmophobia in Juvenile Primary Headaches. Cephalalgia 2008; 28:825-31. [DOI: 10.1111/j.1468-2982.2008.01589.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This study was planned to investigate the prevalence of osmophobia in juvenile headache sufferers and to analyse the diagnostic utility of osmophobia in order to distinguish migraine without aura from episodic tension-type headache. We examined 305 consecutive patients presenting at our Paediatric Headache Centre. A semistructured questionnaire was given to 275 selected patients affected by migraine or tension-type headache. The prevalence of osmophobia during attacks was 18.5%, mainly in migraine patients (25.1%) vs. those with tension-type headache (8.3%). Osmophobia showed more specificity than phonophobia or photophobia in the differential diagnosis between migraine and tension-type headache. In conclusion, this study demonstrates that osmophobia resulted in a symptom with poor sensitivity (27.1%) but high specificity (92%) that could become a supportive diagnostic criterion even in children for the differential diagnosis between migraine without aura and tension-type headache.
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Affiliation(s)
- E Corletto
- Department of Paediatrics, Juvenile Headache Centre, Paediatric Neurology and Psychiatry Unit
| | - L Dal Zotto
- Department of Paediatrics, Juvenile Headache Centre, Paediatric Neurology and Psychiatry Unit
| | - A Resos
- Department of Paediatrics, Juvenile Headache Centre, Paediatric Neurology and Psychiatry Unit
| | - E Tripoli
- Department of Paediatrics, Juvenile Headache Centre, Paediatric Neurology and Psychiatry Unit
| | - G Zanchin
- Department of Neurosciences, Headache Centre, University of Padua Medical School, Padua, Italy
| | - C Bulfoni
- Department of Paediatrics, Juvenile Headache Centre, Paediatric Neurology and Psychiatry Unit
| | - PA Battistella
- Department of Paediatrics, Juvenile Headache Centre, Paediatric Neurology and Psychiatry Unit
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Eidlitz-Markus T, Shuper A, Gorali O, Zeharia A. Migraine and Cephalic Cutaneous Allodynia in Pediatric Patients. Headache 2007; 47:1219-23. [PMID: 17883532 DOI: 10.1111/j.1526-4610.2007.00892.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Allodynia is a central sensitization state characterized by a perception of pain to normally nonpainful stimuli. The objective of this study was to determine the frequency of allodynia in children with migraine and to identify clinical features specific to this patient group.
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Affiliation(s)
- Tal Eidlitz-Markus
- Day Hospitalization Unit, Schneider Children's Medical Center of Israel, Petah Tiqwa, Israel
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