Investigation of the Frequency of Osmophobia in Patients With Primary Headache
preprint
OA: closed
CC-BY-4.0
Abstract
Abstract Introduction: Osmophobia is an isolated phobia that is especially common in patients with primary headaches. Osmophobia is recommended for inclusion in the migraine diagnostic criteria because it increases sensitivity and shows absolute specificity. Although there are publications supporting the frequency of osmophobia in patients with tension-type headache (TTH), the association between TTH and osmophobia has not been definitively demonstrated, and various studies have been conducted on this subject. This study aimed to evaluate the prevalence and clinical characteristics of osmophobia in a cohort of migraine and TTH patients selected from two different centers. Methods: For the current analysis, patients who presented to the neurology outpatient clinic and were diagnosed with migraine or TTH according to the International Classification of Headache Disorders III were selected. A total of 214 patients (129 with migraine and 85 with TTH) were included in the study. Patients’ characteristics, medical visual analog scale (VAS) pain scores and migraine disability assessment (MIDAS) scores wererecorded. Osmophobia characteristics in Migraine and TTH patients were compared along with clinical parameters between the groups and within the groups. Results: Sixty-eight percentof the migraine patientshad osmophobia. The most common type of smell that migraine patients experienced was the scent of perfume. A total of31.3% of the patients with TTH had osmophobia. While the most irritating odorant in migraine patients was perfume, in TTH patients, it was the smell of food. There wereno significant differences between osmophobia and age, education level, disease duration, pain frequency, attack duration, or VAS score in both migraine patients and TTH patients. There was no significant difference between migraine patients with and without osmophobia in termsof the MIDAS score. Discussion: Our study indicates that osmophobia mostly supports migraine as a differential diagnosis in clinical practice. However, osmophobia can be described to a considerable extent in patients with TTH, and it would be useful to use supporting criteria for differential diagnosis and to question the characteristics of osmophobia more deeply.
Full text
86,763 characters
· extracted from
preprint-html
· click to expand
Investigation of the Frequency of Osmophobia in Patients With Primary Headache | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Investigation of the Frequency of Osmophobia in Patients With Primary Headache Esen ÇİÇEKLİ, Semra MUNGAN, Gürdal ORHAN This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4444646/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction : Osmophobia is an isolated phobia that is especially common in patients with primary headaches. Osmophobia is recommended for inclusion in the migraine diagnostic criteria because it increases sensitivity and shows absolute specificity. Although there are publications supporting the frequency of osmophobia in patients with tension-type headache (TTH), the association between TTH and osmophobia has not been definitively demonstrated, and various studies have been conducted on this subject. This study aimed to evaluate the prevalence and clinical characteristics of osmophobia in a cohort of migraine and TTH patients selected from two different centers. Methods : For the current analysis, patients who presented to the neurology outpatient clinic and were diagnosed with migraine or TTH according to the International Classification of Headache Disorders III were selected. A total of 214 patients (129 with migraine and 85 with TTH) were included in the study. Patients’ characteristics, medical visual analog scale (VAS) pain scores and migraine disability assessment (MIDAS) scores wererecorded. Osmophobia characteristics in Migraine and TTH patients were compared along with clinical parameters between the groups and within the groups. Results : Sixty-eight percentof the migraine patientshad osmophobia. The most common type of smell that migraine patients experienced was the scent of perfume. A total of31.3% of the patients with TTH had osmophobia. While the most irritating odorant in migraine patients was perfume, in TTH patients, it was the smell of food. There wereno significant differences between osmophobia and age, education level, disease duration, pain frequency, attack duration, or VAS score in both migraine patients and TTH patients. There was no significant difference between migraine patients with and without osmophobia in termsof the MIDAS score. Discussion : Our study indicates that osmophobia mostly supports migraine as a differential diagnosis in clinical practice. However, osmophobia can be described to a considerable extent in patients with TTH, and it would be useful to use supporting criteria for differential diagnosis and to question the characteristics of osmophobia more deeply. Migraine Tension-Type Headache Osmophobia MIDAS VAS Introduction A sense of smell has been associated with many diseases, especially neurodegenerative diseases, for many years ( 1 ). Abnormal sensitivity to odors and osmophobia have also been associated with headaches of varying frequencies. Osmophobia can be expressed as increased sensitivity to specific odors. It is an isolated phobia that is especially common in patients with primary headaches ( 2 , 3 ). For primary headaches, the diagnosis is mostly supported by anamnesis. Laboratory and imaging methods are only used to exclude secondary causes of headaches. There are no specific criteria for the definitive diagnosis of primary headache. In clinical practice, osmophobia is considered pathognomonic in patients with migraine. These individuals may also exhibit increased odor sensitivity compared to that of normal individuals during the period between attacks. Whether there is a change in odor perception thresholds in migraine patients during the interictal period is controversial ( 4 ). Osmophobia is recommended for inclusion in the migraine diagnostic criteria because it increases sensitivity and shows absolute specificity ( 2 ). Osmophobia is more common in patients with a longer duration of migraine and more migraine-related disorders. These results suggest that sensitivity increases with increasing migraine burden ( 5 , 6 ). Although the relationship between migraine and osmophobia is not clear, connections between the olfactory system and trigeminal nociceptive system have been emphasized ( 7 , 8 ). Although there are publications supporting the frequency of osmophobia in individuals with tension-type headache (TTH), the association between TTH and osmophobia has not been definitively demonstrated, and various studies have been conducted on this subject ( 1 , 9 ). Osmophobia is also present in chronic TTH patients and is prominent in patients with chronic headache and anxiety. It has also been associated with central sensitization symptoms, such as allodynia ( 3 ). Considering this information, other studies have stated that criteria other than osmophobia are required for the differential diagnosis of migraine and TTH ( 10 ). Factors such as the duration of the attack, similarity of accompanying symptoms, and ability of the TTH patient to describe photophobia-phonophobia may make differential diagnosis difficult. For this reason, we believe that symptoms attributed to migraine, such as osmophobia, should be studied frequently and in different populations to increase supporting evidence. This study aimed to evaluate the prevalence and clinical characteristics of osmophobia in a cohort of migraine and TTH patients selected from two different centers. With the data obtained, we aimed to overcome the difficulties in the differential diagnosis of primary headache patients, determine the relationship between osmophobia and chronic headache or severe clinical presentation, evaluate the guiding role of osmophobia in initiating preventive treatment, and contribute to the literature with our own series. Materials and Methods This was a retrospective study based on data collected from the neurology outpatient clinics of Akyazı State Hospital and Ankara City Hospital. This study was approved by the Ankara City Hospital Medical Research Scientific and Ethical Evaluation Board (number 2-24-51). Written informed consent was obtained from all the participants. Patient selection: Current data were obtained from the hospital electronic database of migraine and GTBA patients who visited the neurology outpatient clinics of Akyazı State Hospital and Ankara City Hospital between January 1, 2023, and January 1, 2024. The clinical characteristics of the patients were recorded for retrospective analysis. For the current analysis, patients aged between 18 and 65 years who presented to the neurology outpatient clinic and were diagnosed with migraine or TTH according to the International Classification of Headache Disorders III were selected ( 11 ). Patients with serious general medical diseases such as liver, kidney, and cardiovascular failure; previous or current neurological diseases other than migraine; current or previous psychiatric diseases; or any disease that could cause olfactory disorders were excluded from the study. Patient Evaluation: Patient data, including demographic information, headache type, and pain characteristics, were recorded. Pain intensity was assessed using the visual analog scale (VAS) pain score. For this evaluation, the patient was asked to indicate the severity of his pain with a number from zero to ten. The presence or absence of osmophobia during the attack and interictal periods was recorded using anamnesis information. Pain-related disability in patients with migraine was evaluated using the Migraine Disability Assessment (MIDAS) score, and the patients were divided into four subgroups according to severity (Table 1 ). Table 1 MIDAS Classification MIDAS score Disability MIDAS grade 0–5 Little or no disability I 6–10 Mild disability II 11–20 Moderate disability III 21+ Severe disability IV Statistical analysis: Statistical analysis of the data was performed using IBM SPSS Statistics 23. The data were normally distributed because the skewness and kurtosis values were between − 1.5 and + 1.5. Since the data were normally distributed, the significance of the difference between groups was tested using an independent t test. The significance of the difference in dichotic data between groups was evaluated using the chi-square test. The significance of the differences between more than two groups was tested using ANOVA. Because the groups were not distributed homogeneously according to the Levene test, the Games–Howell test was used as a post hoc test. Results A total of 214 patients (129 with migraine and 85 with TTH) were included in the study. The mean age of the patients was greater than that of the migraine patients (p 0.05). The frequency of pain attacks in TTH patients within one month was greater than that in migraine patients (p < 0.05). The attack duration and VAS score were greater in patients with migraine than in those with TTH (p < 0.05) (Table 2). Tale 2. Age, Education Level, Disease Duration, Pain Frequency, Attack Duration, and VAS Score Characteristics of the Migraine and TTH Groups Ort ± SD P value Age Migraine 36.26±9.64 < 0.001* TTH 43.07±13.00 Education level Migraine 2.39±1.26 0.64 TTH 2.31±1.13 Disease duration (year) Migraine 8.37±8.07 0.218 TTH 7.07±6.76 Pain frequency (in a month) Migraine 4.49±3.52 < 0.001* TTH 6.91±3.35 Attack duration (hour) Migraine 42.03±25.35 < 0.001* TTH 13.05±14.24 VAS score Migraine 8.10±1.56 < 0.001* TTH 6.84±1.34 Osmophobia was more common in migraine patients than in TTH patients, and the frequency of osmophobia was also greater during the nonattack period in migraine patients (p 0.05) (Table 3 ). Table 3 Osmophobia and Analgesic Abuse Frequency in Migraine and TTH Patients. N P value Osmophobia Migraine 87 < 0.001 TTH 22 Total 109 Osmophobia in the nonattack period Migraine 40 < 0.001 TTH 10 Total 50 Analgesic abuse Migraine 41 0.581 TTH 24 Total 65 Sixty-eight percent of the patients with migraine had osmophobia. The most common type of smell that migraine patients experienced was the scent of perfume. The smell of the perfume was followed by the smell of food, cigarettes, and sweat. A total of 31.3% of the patients with TTH had osmophobia. The odor of TTH patients was the most disturbed by the smell of food, followed by the smell of cigarettes and perfumes (Table 4 ). Table 4 The Type of Odors That Migraine and TTH Patients Were Disturbed Migraine TTH N % N % Perfume 40 32 5 5.8 Detergent 6 4.7 3 3.5 Cigarettes 8 6.3 7 8.2 Bleach 2 1.6 1 1.1 Food 19 14.8 9 10.5 Coffee 1 0.8 0 0 Onion-Garlic 2 1.6 1 1.1 Sweat 7 5.4 0 0 Spices 1 0.8 1 1.1 Non 40 32 59 68.7 Total 128 100 86 100 There were no significant differences in osmophobia or age, education level, disease duration, pain frequency, attack duration, or VAS score between migraine patients and TTH patients. There was no significant difference between migraine patients with and without osmophobia in terms of the MIDAS score (Table 5 ). Table 5 Relationships between Osmophobia and Age, Education Level, Disease Duration, Pain Frequency, Pain Duration, and VAS Scores in Migraine and TTH Patients and between Osmophobia and MIDAS Scores in Migraine Patients MIGRAINE TTH Ort ± SD P value Ort ± SD P value Age Osmophobia + 35.12±9.14 0.053 40.90±12.96 0.368 Osmophobia - 38.61±10.30 43.82±13.04 Education level Osmophobia + 2.50±1.24 0.603 2.50±1.10 0.417 Osmophobia - 2.38±1.32 2.26±1.15 Disease duration (year) Osmophobia + 7.72±8.02 0.189 6.00±7.13 0.392 Osmophobia - 9.72±8.10 7.44±6.64 Pain frequency (in a month) Osmophobia + 4.37±3.50 0.590 6.50±3.50 0.488 Osmophobia - 4.73±3.60 7.06±3.18 Pain duration (hour) Osmophobia + 40.63±23.92 0.369 13.18±16.61 0.963 Osmophobia - 44.92±28.16 13.01±13.47 VAS score Osmophobia + 8.13±1.62 0.760 6.63±1.25 0.395 Osmophobia - 8.04±1.44 6.92±1.37 MIDAS score Osmophobia + 2.42±1.04 0.645 Osmophobia - 2.33±1.09 VAS and MIDAS scores were greater in migraine patients with analgesic abuse than in those without. The educational level of migraine patients with analgesic abuse was lower than that of those without abuse (p < 0.05). The mean age, disease duration, pain frequency, and mean VAS score of TTH patients with analgesic abuse were greater than those of patients without abuse (p 0.05). Discussion In our study, 68% of patients with migraine had osmophobia. Although studies have shown that the frequency of osmophobia is similar in migraine patients, the frequency of osmophobia in migraine patients is reported to be between 25% and 95%. ( 2 , 12 , 13 ) Some studies investigating osmophobia during attacks have reported that osmophobia is observed only in migraine patients and not in TTH patients, and it has been concluded that osmophobia during attacks is specific to migraines ( 1 , 2 ). In our study, although there were TTH patients who experienced osmophobia both during attacks and during the interattack period, the number of these patients was significantly lower than that of migraine patients. Considering these findings, it seems to be a more appropriate protocol in clinical practice to consider migraine first in patients who describe intense osmophobia and whose diagnosis is in doubt and to organize first-line treatment according to migraine. In a study of 113 migraine patients, osmophobia was most frequently observed with the smell of perfume, and no significant difference was found between the migraine with and without aura groups ( 14 ). Similarly, we found that osmophobia in patients with migraine who participated in our study was most frequent in perfume scents. In patients with TTH, the most common sensitivity was for food odors. Perfumes ranked third among these patients. During patient evaluation, detailed questioning of which odors the patient is sensitive to may support the differential diagnosis. However, it may be useful to warn and inform patients with migraine and their relatives about osmophobia and smells that may trigger attacks. Perhaps, in detailed studies to be conducted in larger populations, the scents to which migraine patients are sensitive can be determined, and the cosmetics industry can focus on perfumes and unscented cosmetics that migraine patients can use more easily. Although our study did not show a relationship between disease duration and osmophobia in migraine and TTH patients, there are publications that find a significant relationship, especially in migraine patients ( 5 ). It would be appropriate to keep in mind that patients who do not have osmophobia in the first years of migraine diagnosis may develop osmophobia as the duration of the disease increases and to question osmophobia at every examination. The MIDAS scores of those with osmophobia in the migraine group were slightly greater than those of those without osmophobia, but the difference was not statistically significant. Many studies have shown that the frequency of osmophobia increases as the MIDAS score increases ( 5 , 6 , 15 ). We believe that more definitive results can be obtained with studies in which the number of patients is increased. When age, education level, disease duration, pain frequency, attack duration, and VAS score were examined in both groups of patients, no statistically significant differences were found between any of these parameters and osmophobia. The perception of scents is an extremely subjective experience. This is a limitation of this study. Even a patient's current mood can affect his response. Therefore, the results of studies evaluating migraine-triggering scents have yielded controversial interpretations. In studies conducted with functional MRI, increased activity was detected in olfactory brain regions, such as the prefrontal, cingulate, and temporal cortices, of migraine patients with osmophobia. This activity is suppressed by typical antipsychotics ( 16 , 17 ). Although olfactory hallucinations and phantosmia are symptoms particularly associated with temporal lobe epilepsy, these symptoms were detected in a small number of patients in a headache center. Patients with normal electroencephalograms respond positively to antiepileptic treatment ( 18 ). Recently, a hospital-based study in Taiwan reported that patients with osmophobia were more likely to have higher levels of depression and anxiety than were those without osmophobia ( 19 ). For the differential diagnosis and treatment of headache, in-depth questioning should be conducted while taking anamnesis, and the characteristics of osmophobia and its accompanying conditions should be questioned. The aim should be to increase the patient's quality of life through strict control by using treatment agents that can cover the patient's comorbidities and reduce osmophobia. We hope that new studies that question the sense of taste, which is a close accompaniment of smell, in patients with migraine and tension-type headaches, including anxiety and depression scales, will shed light on the literature. Conclusion Our study indicates that osmophobia mostly supports migraine as a differential diagnosis in clinical practice. However, osmophobia can be described to a considerable extent in patients with TTH, and it would be useful to use supporting criteria for differential diagnosis and to question the characteristics of osmophobia more deeply. There is a need for further studies on this subject that include different parameters in a large patient series. Abbreviations TTH tension-type headache VAS Visual analog scale MIDAS Migraine Disability Assessment Scale Declarations Ethical approval and consent to Participate: This research was approved by Ankara City Hospital Ethics Committee (No: 2-24-51). We declare that the study was conducted in accordance with the Declaration of Helsinki and that all tasks were performed with sufficient understanding and written consent from the subjects. Consent for publication: The manuscript does not contain any individual person’s data as in details, images or videos. Competing interests: The authors declare no competing interests. Funding: None Author Contribution Concept: E.C., S.M.Design: E.C.Data collection or processing: E.C., S.M., G.O.Analysis or Interpretation: E.C.Literature search: E.C.,S.M.,G.O.Writing: E.CAll authors reviewed the manuscript Data Availability We can provide our Excel and SPSS data files upon request. References 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. 2007;27(9):1061-1068. doi:10.1111/j.1468-2982.2007.01421.x 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. 2020;40(4):337–346. doi: 10.1177/0333102419877661. 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 Sep 18;22(1):109. doi: 10.1186/s10194-021-01327-2. PMID: 34537019; PMCID: PMC8449918. Demarquay G, Royet J, Giraud P, Chazot G, Valade D, Ryvlin P. Rating of Olfactory Judgments in Migraine Patients. Cephalalgia. 2006;26(9):1123-1130. doi:10.1111/j.1468-2982.2006.01174.x Gossrau G, Frost M, Klimova A, Koch T, Sabatowski R, Mignot C, Haehner A. Interictal osmophobia is associated with longer migraine disease duration. J Headache Pain. 2022 Jul 15;23(1):81. doi: 10.1186/s10194-022-01451-7. PMID: 35840888; PMCID: PMC9284850 Meşe Pekdemir, E., Tanik, N. Clinical significance of osmophobia and its effect on quality of life in people with migraine. Acta Neurol Belg 123, 1747–1755 (2023). Stankewitz A, May A. Increased limbic and brainstem activity during migraine attacks following olfactory stimulation. Neurology 2011;77(5):476–82. Silva-Néto RP, Peres MF, Valença MM. Accuracy of osmophobia in the differential diagnosis between migraine and tension-type headache. J Neurol Sci. 2014 Apr 15;339(1-2):118-22. doi: 10.1016/j.jns.2014.01.040. Epub 2014 Feb 6. PMID: 24560462. Porta-Etessam J, Casanova I, García-Cobos R, Lapeña T, Fernández MJ, García-Ramos R, Serna C. Osmophobia analysis in primary headeache. Neurologia. 2009 Jun;24(5):315-7. PMID: 19642034) Chitsaz A, Ghorbani A, Dashti M, Khosravi M, Kianmehr M. The Prevalence of Osmophobia in Migranous and Episodic Tension Type Headaches. Adv Biomed Res. 2017 Apr 17;6:44. doi: 10.4103/2277-9175.204587. PMID: 28503499; PMCID: PMC5414411. Headache Classification Committee of the International Headache Society (IHS) The international classification of headache disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211. doi: 10.1177/0333102417738202. Wang Y-F, Fuh J-L, Chen S-P, Wu J-C, Wang S-J. Clinical correlates and diagnostic utility of osmophobia in migraine. Cephalalgia. 2012;32(16):1180-1188. doi:10.1177/0333102412461401 Nermin Tanik, Murat Bektas, Development of Quality of Life Assessment Questionnaire Associated with Osmophobia in People with Migraine, Pain Medicine, Volume 23, Issue 5, May 2022, Pages 1006–1014 Fornazieri MA, Neto AR, de Rezende Pinna F, Gobbi Porto FH, de Lima Navarro P, Voegels RL, Doty RL. Olfactory symptoms reported by migraineurs with and without auras. Headache. 2016 Nov;56(10):1608-1616. doi: 10.1111/head.12973. Epub 2016 Oct 25. PMID: 27779326. Suzuki K, Suzuki S, Shiina T, Okamura M, Haruyama Y, Tatsumoto M, Hirata K. Investigating the relationships between the burden of multiple sensory hypersensitivity symptoms and headache-related disability in patents with migraine. J Headache Pain. 2021 Jul 19;22(1):77. doi: 10.1186/s10194-021-01294-8. PMID: 34281498; PMCID: PMC8287675. Villar-Martinez MD, Goadsby PJ. Pathophysiology and Therapy of Associated Features of Migraine. Cells. 2022 Sep 5;11(17):2767. doi: 10.3390/cells11172767. PMID: 36078174; PMCID: PMC9455236. Henkin R.I., Levy L.M., Lin C.S. Taste and smell phantoms revealed by brain functional MRI (fMRI) J. Comput. Assist. Tomogr. 2000;24:106–123. doi: 10.1097/00004728-200001000-00022. Coleman E.R., Grosberg B.M., Robbins M.S. Olfactory hallucinations in primary headache disorders: Case series and literature review. Cephalalgia. 2011;31:1477–1489. doi: 10.1177/0333102411423315. Park SP, Seo JG, Lee WK. Osmophobia and allodynia are critical factors for suicidality in patients with migraine. J Headache Pain. 2015;16:529. doi: 10.1186/s10194-015-0529-1. Epub 2015 May 12. PMID: 25968102; PMCID: PMC4434243. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4444646","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":313620009,"identity":"a638e76c-8cb0-4c9a-89af-792e208f8f28","order_by":0,"name":"Esen ÇİÇEKLİ","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIiWNgGAWjYNACAwYeBvYGEMOCBC08PAdADAkSLOKRSABRRGjh5z987MGPgnsy9pLPr274USDBwN/enYBXi+SMtHTDHoNiHh7pnLKbPUCHSZw5uwGvFoMbPGbSDAYJIC1pN3iAWgwkcvFrsT9//htEi+SZtJt/iNFiwJDDBtEiwX7sNlG2SNxIM5PsAWk5k8N2W8ZAgoegX/j7Dz+T+PEnwZ69/fizm2/+2Mjxt/fi14IEeAzAJLHKQYD9ASmqR8EoGAWjYAQBAGIVPazgygmHAAAAAElFTkSuQmCC","orcid":"","institution":"Department of Neurology, Akyazı State Hospital, Sakarya, Turkey","correspondingAuthor":true,"prefix":"","firstName":"Esen","middleName":"","lastName":"ÇİÇEKLİ","suffix":""},{"id":313620010,"identity":"46dbe013-9f8f-49eb-9c1c-e4d58ef53de6","order_by":1,"name":"Semra MUNGAN","email":"","orcid":"","institution":"Department of Neurology, Ankara City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Semra","middleName":"","lastName":"MUNGAN","suffix":""},{"id":313620011,"identity":"3abe53ab-db75-4944-9bb3-3d86cbdf71c0","order_by":2,"name":"Gürdal ORHAN","email":"","orcid":"","institution":"Department of Neurology, Ankara City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Gürdal","middleName":"","lastName":"ORHAN","suffix":""}],"badges":[],"createdAt":"2024-05-19 14:23:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4444646/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4444646/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58677850,"identity":"72b19457-cb9b-4406-ac8e-a35e3fb9feed","added_by":"auto","created_at":"2024-06-19 16:29:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":453906,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4444646/v1/a19f6e5a-5dae-4d2b-85fd-b7c86c5467c9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eInvestigation of the Frequency of Osmophobia in Patients With Primary Headache\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eA sense of smell has been associated with many diseases, especially neurodegenerative diseases, for many years (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Abnormal sensitivity to odors and osmophobia have also been associated with headaches of varying frequencies. Osmophobia can be expressed as increased sensitivity to specific odors. It is an isolated phobia that is especially common in patients with primary headaches (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFor primary headaches, the diagnosis is mostly supported by anamnesis. Laboratory and imaging methods are only used to exclude secondary causes of headaches. There are no specific criteria for the definitive diagnosis of primary headache. In clinical practice, osmophobia is considered pathognomonic in patients with migraine. These individuals may also exhibit increased odor sensitivity compared to that of normal individuals during the period between attacks. Whether there is a change in odor perception thresholds in migraine patients during the interictal period is controversial (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOsmophobia is recommended for inclusion in the migraine diagnostic criteria because it increases sensitivity and shows absolute specificity (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Osmophobia is more common in patients with a longer duration of migraine and more migraine-related disorders. These results suggest that sensitivity increases with increasing migraine burden (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Although the relationship between migraine and osmophobia is not clear, connections between the olfactory system and trigeminal nociceptive system have been emphasized (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough there are publications supporting the frequency of osmophobia in individuals with tension-type headache (TTH), the association between TTH and osmophobia has not been definitively demonstrated, and various studies have been conducted on this subject (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Osmophobia is also present in chronic TTH patients and is prominent in patients with chronic headache and anxiety. It has also been associated with central sensitization symptoms, such as allodynia (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Considering this information, other studies have stated that criteria other than osmophobia are required for the differential diagnosis of migraine and TTH (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFactors such as the duration of the attack, similarity of accompanying symptoms, and ability of the TTH patient to describe photophobia-phonophobia may make differential diagnosis difficult. For this reason, we believe that symptoms attributed to migraine, such as osmophobia, should be studied frequently and in different populations to increase supporting evidence. This study aimed to evaluate the prevalence and clinical characteristics of osmophobia in a cohort of migraine and TTH patients selected from two different centers. With the data obtained, we aimed to overcome the difficulties in the differential diagnosis of primary headache patients, determine the relationship between osmophobia and chronic headache or severe clinical presentation, evaluate the guiding role of osmophobia in initiating preventive treatment, and contribute to the literature with our own series.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis was a retrospective study based on data collected from the neurology outpatient clinics of Akyazı State Hospital and Ankara City Hospital.\u003c/p\u003e \u003cp\u003e This study was approved by the Ankara City Hospital Medical Research Scientific and Ethical Evaluation Board (number 2-24-51). Written informed consent was obtained from all the participants.\u003c/p\u003e \u003cp\u003ePatient selection:\u003c/p\u003e \u003cp\u003eCurrent data were obtained from the hospital electronic database of migraine and GTBA patients who visited the neurology outpatient clinics of Akyazı State Hospital and Ankara City Hospital between January 1, 2023, and January 1, 2024. The clinical characteristics of the patients were recorded for retrospective analysis. For the current analysis, patients aged between 18 and 65 years who presented to the neurology outpatient clinic and were diagnosed with migraine or TTH according to the International Classification of Headache Disorders III were selected (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Patients with serious general medical diseases such as liver, kidney, and cardiovascular failure; previous or current neurological diseases other than migraine; current or previous psychiatric diseases; or any disease that could cause olfactory disorders were excluded from the study.\u003c/p\u003e \u003cp\u003ePatient Evaluation:\u003c/p\u003e \u003cp\u003ePatient data, including demographic information, headache type, and pain characteristics, were recorded. Pain intensity was assessed using the visual analog scale (VAS) pain score. For this evaluation, the patient was asked to indicate the severity of his pain with a number from zero to ten. The presence or absence of osmophobia during the attack and interictal periods was recorded using anamnesis information. Pain-related disability in patients with migraine was evaluated using the Migraine Disability Assessment (MIDAS) score, and the patients were divided into four subgroups according to severity (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMIDAS Classification\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMIDAS score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisability\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMIDAS grade\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLittle or no disability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild disability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate disability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere disability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIV\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis:\u003c/h2\u003e \u003cp\u003eStatistical analysis of the data was performed using IBM SPSS Statistics 23. The data were normally distributed because the skewness and kurtosis values were between \u0026minus;\u0026thinsp;1.5 and +\u0026thinsp;1.5. Since the data were normally distributed, the significance of the difference between groups was tested using an independent t test. The significance of the difference in dichotic data between groups was evaluated using the chi-square test. The significance of the differences between more than two groups was tested using ANOVA. Because the groups were not distributed homogeneously according to the Levene test, the Games\u0026ndash;Howell test was used as a post hoc test.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 214 patients (129 with migraine and 85 with TTH) were included in the study.\u003c/p\u003e \u003cp\u003eThe mean age of the patients was greater than that of the migraine patients (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was no significant difference between migraine patients and TTH patients in terms of education level or years of pain (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The frequency of pain attacks in TTH patients within one month was greater than that in migraine patients (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The attack duration and VAS score were greater in patients with migraine than in those with TTH (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;2).\u003c/p\u003e \u003cp\u003e \u003cb\u003eTale 2. Age, Education Level, Disease Duration, Pain Frequency, Attack Duration, and VAS Score Characteristics of the Migraine and TTH Groups\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOrt \u0026plusmn; SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMigraine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e36.26\u0026plusmn;9.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTTH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e43.07\u0026plusmn;13.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMigraine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.39\u0026plusmn;1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTTH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.31\u0026plusmn;1.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDisease duration (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMigraine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e8.37\u0026plusmn;8.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.218\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTTH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.07\u0026plusmn;6.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePain frequency (in a month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMigraine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.49\u0026plusmn;3.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTTH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.91\u0026plusmn;3.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAttack duration (hour)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMigraine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e42.03\u0026plusmn;25.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTTH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e13.05\u0026plusmn;14.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVAS score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMigraine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e8.10\u0026plusmn;1.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTTH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.84\u0026plusmn;1.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOsmophobia was more common in migraine patients than in TTH patients, and the frequency of osmophobia was also greater during the nonattack period in migraine patients (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was no difference in analgesic abuse between the migraine and TTH groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOsmophobia and Analgesic Abuse Frequency in Migraine and TTH Patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eOsmophobia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMigraine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTTH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eOsmophobia in the nonattack period\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMigraine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTTH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAnalgesic abuse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMigraine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.581\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTTH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSixty-eight percent of the patients with migraine had osmophobia. The most common type of smell that migraine patients experienced was the scent of perfume. The smell of the perfume was followed by the smell of food, cigarettes, and sweat. A total of 31.3% of the patients with TTH had osmophobia. The odor of TTH patients was the most disturbed by the smell of food, followed by the smell of cigarettes and perfumes (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe Type of Odors That Migraine and TTH Patients Were Disturbed\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMigraine\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eTTH\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerfume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDetergent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCigarettes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBleach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoffee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnion-Garlic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSweat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere were no significant differences in osmophobia or age, education level, disease duration, pain frequency, attack duration, or VAS score between migraine patients and TTH patients. There was no significant difference between migraine patients with and without osmophobia in terms of the MIDAS score (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelationships between Osmophobia and Age, Education Level, Disease Duration, Pain Frequency, Pain Duration, and VAS Scores in Migraine and TTH Patients and between Osmophobia and MIDAS Scores in Migraine Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMIGRAINE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eTTH\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOrt \u0026plusmn; SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOrt \u0026plusmn; SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOsmophobia +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.12\u0026plusmn;9.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40.90\u0026plusmn;12.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.368\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOsmophobia -\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.61\u0026plusmn;10.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43.82\u0026plusmn;13.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOsmophobia +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.50\u0026plusmn;1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.603\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.50\u0026plusmn;1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.417\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOsmophobia -\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.38\u0026plusmn;1.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.26\u0026plusmn;1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisease duration (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOsmophobia +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.72\u0026plusmn;8.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.00\u0026plusmn;7.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.392\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOsmophobia -\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.72\u0026plusmn;8.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.44\u0026plusmn;6.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain frequency (in a month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOsmophobia +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.37\u0026plusmn;3.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.590\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.50\u0026plusmn;3.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.488\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOsmophobia -\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.73\u0026plusmn;3.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.06\u0026plusmn;3.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain duration (hour)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOsmophobia +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.63\u0026plusmn;23.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.369\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.18\u0026plusmn;16.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.963\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOsmophobia -\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.92\u0026plusmn;28.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.01\u0026plusmn;13.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOsmophobia +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.13\u0026plusmn;1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.760\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.63\u0026plusmn;1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.395\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOsmophobia -\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.04\u0026plusmn;1.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.92\u0026plusmn;1.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMIDAS score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOsmophobia +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.42\u0026plusmn;1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.645\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOsmophobia -\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.33\u0026plusmn;1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eVAS and MIDAS scores were greater in migraine patients with analgesic abuse than in those without. The educational level of migraine patients with analgesic abuse was lower than that of those without abuse (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eThe mean age, disease duration, pain frequency, and mean VAS score of TTH patients with analgesic abuse were greater than those of patients without abuse (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eThere was no statistically significant relationship between osmophobia and analgesic abuse in patients with migraine or TTH (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our study, 68% of patients with migraine had osmophobia. Although studies have shown that the frequency of osmophobia is similar in migraine patients, the frequency of osmophobia in migraine patients is reported to be between 25% and 95%. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eSome studies investigating osmophobia during attacks have reported that osmophobia is observed only in migraine patients and not in TTH patients, and it has been concluded that osmophobia during attacks is specific to migraines (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In our study, although there were TTH patients who experienced osmophobia both during attacks and during the interattack period, the number of these patients was significantly lower than that of migraine patients. Considering these findings, it seems to be a more appropriate protocol in clinical practice to consider migraine first in patients who describe intense osmophobia and whose diagnosis is in doubt and to organize first-line treatment according to migraine.\u003c/p\u003e \u003cp\u003eIn a study of 113 migraine patients, osmophobia was most frequently observed with the smell of perfume, and no significant difference was found between the migraine with and without aura groups (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Similarly, we found that osmophobia in patients with migraine who participated in our study was most frequent in perfume scents. In patients with TTH, the most common sensitivity was for food odors. Perfumes ranked third among these patients. During patient evaluation, detailed questioning of which odors the patient is sensitive to may support the differential diagnosis. However, it may be useful to warn and inform patients with migraine and their relatives about osmophobia and smells that may trigger attacks. Perhaps, in detailed studies to be conducted in larger populations, the scents to which migraine patients are sensitive can be determined, and the cosmetics industry can focus on perfumes and unscented cosmetics that migraine patients can use more easily.\u003c/p\u003e \u003cp\u003eAlthough our study did not show a relationship between disease duration and osmophobia in migraine and TTH patients, there are publications that find a significant relationship, especially in migraine patients (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). It would be appropriate to keep in mind that patients who do not have osmophobia in the first years of migraine diagnosis may develop osmophobia as the duration of the disease increases and to question osmophobia at every examination.\u003c/p\u003e \u003cp\u003eThe MIDAS scores of those with osmophobia in the migraine group were slightly greater than those of those without osmophobia, but the difference was not statistically significant. Many studies have shown that the frequency of osmophobia increases as the MIDAS score increases (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). We believe that more definitive results can be obtained with studies in which the number of patients is increased.\u003c/p\u003e \u003cp\u003eWhen age, education level, disease duration, pain frequency, attack duration, and VAS score were examined in both groups of patients, no statistically significant differences were found between any of these parameters and osmophobia. The perception of scents is an extremely subjective experience. This is a limitation of this study. Even a patient's current mood can affect his response. Therefore, the results of studies evaluating migraine-triggering scents have yielded controversial interpretations.\u003c/p\u003e \u003cp\u003eIn studies conducted with functional MRI, increased activity was detected in olfactory brain regions, such as the prefrontal, cingulate, and temporal cortices, of migraine patients with osmophobia. This activity is suppressed by typical antipsychotics (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Although olfactory hallucinations and phantosmia are symptoms particularly associated with temporal lobe epilepsy, these symptoms were detected in a small number of patients in a headache center. Patients with normal electroencephalograms respond positively to antiepileptic treatment (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Recently, a hospital-based study in Taiwan reported that patients with osmophobia were more likely to have higher levels of depression and anxiety than were those without osmophobia (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFor the differential diagnosis and treatment of headache, in-depth questioning should be conducted while taking anamnesis, and the characteristics of osmophobia and its accompanying conditions should be questioned. The aim should be to increase the patient's quality of life through strict control by using treatment agents that can cover the patient's comorbidities and reduce osmophobia.\u003c/p\u003e \u003cp\u003eWe hope that new studies that question the sense of taste, which is a close accompaniment of smell, in patients with migraine and tension-type headaches, including anxiety and depression scales, will shed light on the literature.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study indicates that osmophobia mostly supports migraine as a differential diagnosis in clinical practice. However, osmophobia can be described to a considerable extent in patients with TTH, and it would be useful to use supporting criteria for differential diagnosis and to question the characteristics of osmophobia more deeply. There is a need for further studies on this subject that include different parameters in a large patient series.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTTH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003etension-type headache\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVisual analog scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMIDAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMigraine Disability Assessment Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to Participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was approved by Ankara City Hospital Ethics Committee (No: 2-24-51). We declare that the study was conducted in accordance with the Declaration of Helsinki and that all tasks were performed with sufficient understanding and written consent from the subjects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe manuscript does not contain any individual person\u0026rsquo;s data as in details, images or videos.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConcept: E.C., S.M.Design: E.C.Data collection or processing: E.C., S.M., G.O.Analysis or Interpretation: E.C.Literature search: E.C.,S.M.,G.O.Writing: E.CAll authors reviewed the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe can provide our Excel and SPSS data files upon request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZanchin 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. 2007;27(9):1061-1068. doi:10.1111/j.1468-2982.2007.01421.x\u003c/li\u003e\n\u003cli\u003eTerrin 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. 2020;40(4):337\u0026ndash;346. doi: 10.1177/0333102419877661.\u003c/li\u003e\n\u003cli\u003eDelussi M, Laporta A, Fraccalvieri I, de Tommaso M. Osmophobia in primary headache patients: associated symptoms and response to preventive treatments. J Headache Pain. 2021 Sep 18;22(1):109. doi: 10.1186/s10194-021-01327-2. PMID: 34537019; PMCID: PMC8449918.\u003c/li\u003e\n\u003cli\u003eDemarquay G, Royet J, Giraud P, Chazot G, Valade D, Ryvlin P. Rating of Olfactory Judgments in Migraine Patients. Cephalalgia. 2006;26(9):1123-1130. doi:10.1111/j.1468-2982.2006.01174.x\u003c/li\u003e\n\u003cli\u003eGossrau G, Frost M, Klimova A, Koch T, Sabatowski R, Mignot C, Haehner A. Interictal osmophobia is associated with longer migraine disease duration. J Headache Pain. 2022 Jul 15;23(1):81. doi: 10.1186/s10194-022-01451-7. PMID: 35840888; PMCID: PMC9284850\u003c/li\u003e\n\u003cli\u003eMeşe Pekdemir, E., Tanik, N. Clinical significance of osmophobia and its effect on quality of life in people with migraine. Acta Neurol Belg 123, 1747\u0026ndash;1755 (2023).\u003c/li\u003e\n\u003cli\u003eStankewitz A, May A. Increased limbic and brainstem activity during migraine attacks following olfactory stimulation. Neurology 2011;77(5):476\u0026ndash;82.\u003c/li\u003e\n\u003cli\u003eSilva-N\u0026eacute;to RP, Peres MF, Valen\u0026ccedil;a MM. Accuracy of osmophobia in the differential diagnosis between migraine and tension-type headache. J Neurol Sci. 2014 Apr 15;339(1-2):118-22. doi: 10.1016/j.jns.2014.01.040. Epub 2014 Feb 6. PMID: 24560462.\u003c/li\u003e\n\u003cli\u003ePorta-Etessam J, Casanova I, Garc\u0026iacute;a-Cobos R, Lape\u0026ntilde;a T, Fern\u0026aacute;ndez MJ, Garc\u0026iacute;a-Ramos R, Serna C. Osmophobia analysis in primary headeache. Neurologia. 2009 Jun;24(5):315-7. PMID: 19642034)\u003c/li\u003e\n\u003cli\u003eChitsaz A, Ghorbani A, Dashti M, Khosravi M, Kianmehr M. The Prevalence of Osmophobia in Migranous and Episodic Tension Type Headaches. Adv Biomed Res. 2017 Apr 17;6:44. doi: 10.4103/2277-9175.204587. PMID: 28503499; PMCID: PMC5414411.\u003c/li\u003e\n\u003cli\u003eHeadache Classification Committee of the International Headache Society (IHS) The international classification of headache disorders, 3rd edition. Cephalalgia. 2018;38(1):1\u0026ndash;211. doi: 10.1177/0333102417738202.\u003c/li\u003e\n\u003cli\u003eWang Y-F, Fuh J-L, Chen S-P, Wu J-C, Wang S-J. Clinical correlates and diagnostic utility of osmophobia in migraine. Cephalalgia. 2012;32(16):1180-1188. doi:10.1177/0333102412461401\u003c/li\u003e\n\u003cli\u003eNermin Tanik, Murat Bektas, Development of Quality of Life Assessment Questionnaire Associated with Osmophobia in People with Migraine, Pain Medicine, Volume 23, Issue 5, May 2022, Pages 1006\u0026ndash;1014\u003c/li\u003e\n\u003cli\u003eFornazieri MA, Neto AR, de Rezende Pinna F, Gobbi Porto FH, de Lima Navarro P, Voegels RL, Doty RL. Olfactory symptoms reported by migraineurs with and without auras. Headache. 2016 Nov;56(10):1608-1616. doi: 10.1111/head.12973. Epub 2016 Oct 25. PMID: 27779326.\u003c/li\u003e\n\u003cli\u003eSuzuki K, Suzuki S, Shiina T, Okamura M, Haruyama Y, Tatsumoto M, Hirata K. Investigating the relationships between the burden of multiple sensory hypersensitivity symptoms and headache-related disability in patents with migraine. J Headache Pain. 2021 Jul 19;22(1):77. doi: 10.1186/s10194-021-01294-8. PMID: 34281498; PMCID: PMC8287675.\u003c/li\u003e\n\u003cli\u003eVillar-Martinez MD, Goadsby PJ. Pathophysiology and Therapy of Associated Features of Migraine. Cells. 2022 Sep 5;11(17):2767. doi: 10.3390/cells11172767. PMID: 36078174; PMCID: PMC9455236.\u003c/li\u003e\n\u003cli\u003eHenkin R.I., Levy L.M., Lin C.S. Taste and smell phantoms revealed by brain functional MRI (fMRI) J. Comput. Assist. Tomogr. 2000;24:106\u0026ndash;123. doi: 10.1097/00004728-200001000-00022.\u003c/li\u003e\n\u003cli\u003eColeman E.R., Grosberg B.M., Robbins M.S. Olfactory hallucinations in primary headache disorders: Case series and literature review. Cephalalgia. 2011;31:1477\u0026ndash;1489. doi: 10.1177/0333102411423315.\u003c/li\u003e\n\u003cli\u003ePark SP, Seo JG, Lee WK. Osmophobia and allodynia are critical factors for suicidality in patients with migraine. J Headache Pain. 2015;16:529. doi: 10.1186/s10194-015-0529-1. Epub 2015 May 12. PMID: 25968102; PMCID: PMC4434243.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Migraine, Tension-Type Headache, Osmophobia, MIDAS, VAS","lastPublishedDoi":"10.21203/rs.3.rs-4444646/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4444646/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eOsmophobia is an isolated phobia that is especially common in patients with primary headaches. Osmophobia is recommended for inclusion in the migraine diagnostic criteria because it increases sensitivity and shows absolute specificity. Although there are publications supporting the frequency of osmophobia in patients with tension-type headache (TTH), the association between TTH and osmophobia has not been definitively demonstrated, and various studies have been conducted on this subject. This study aimed to evaluate the prevalence and clinical characteristics of osmophobia in a cohort of migraine and TTH patients selected from two different centers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eFor the current analysis, patients who presented to the neurology outpatient clinic and were diagnosed with migraine or TTH according to the International Classification of Headache Disorders III were selected. A total of 214 patients (129 with migraine and 85 with TTH) were included in the study. Patients’ characteristics, medical visual analog scale (VAS) pain scores and migraine disability assessment (MIDAS) scores wererecorded. Osmophobia characteristics in Migraine and TTH patients were compared along with clinical parameters between the groups and within the groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eSixty-eight percentof the migraine patientshad osmophobia. The most common type of smell that migraine patients experienced was the scent of perfume. A total of31.3% of the patients with TTH had osmophobia. While the most irritating odorant in migraine patients was perfume, in TTH patients, it was the smell of food. There wereno significant differences between osmophobia and age, education level, disease duration, pain frequency, attack duration, or VAS score in both migraine patients and TTH patients. There was no significant difference between migraine patients with and without osmophobia in termsof the MIDAS score.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eOur study indicates that osmophobia mostly supports migraine as a differential diagnosis in clinical practice. However, osmophobia can be described to a considerable extent in patients with TTH, and it would be useful to use supporting criteria for differential diagnosis and to question the characteristics of osmophobia more deeply.\u003c/p\u003e","manuscriptTitle":"Investigation of the Frequency of Osmophobia in Patients With Primary Headache","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-13 11:20:55","doi":"10.21203/rs.3.rs-4444646/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5fd689b9-1fc7-48ac-8fbc-add55896af32","owner":[],"postedDate":"June 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-19T16:20:59+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-13 11:20:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4444646","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4444646","identity":"rs-4444646","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}
Text is read by the "Ask this paper" AI Q&A widget below. Extraction quality varies by source — PMC NXML preserves structure cleanly, OA-HTML may include some navigation residue, and OA-PDF can have broken hyphenation. The publisher copy (via DOI) is the canonical version.
My notes (saved in your browser only)
Ask this paper
Answers must be backed by verbatim quotes from this paper's full text. Hallucinated quotes are dropped automatically; if no verbatim passage answers the question, we say so. How this works
Outcome instruments
Citation neighborhood (no data yet)
We don't have any in-corpus citations linked to this paper yet. This is a recent paper (2024) — citers typically take a year or two to land, and the OpenAlex reference graph may still be filling in.
Source provenance
- europepmc
- last seen: 2026-05-20T01:45:00.602351+00:00
- unpaywall
- last seen: 2026-05-24T02:00:01.246996+00:00
License: CC-BY-4.0