Osmophobia May Be a Clinical Diagnostic Marker of Pediatric Migraine

Little child being sick and holding her hand pressed against her forehead
Study researchers evaluated the potential of osmophobia in as a clinical diagnostic marker of migraine in children and adolescents.

Osmophobia, defined as aversion to or dislike of odors, could be a clinical diagnostic marker for migraine among children and adolescents, according to a letter to the editor published in Headache.

Osmophobia is more common in patients with other migraine symptoms, but as symptoms are less frequent in children with migraine, it was important to study osmophobia in this population; this was the primary objective of Sampaio Rocha-Filho and colleagues.

In their study, the researchers found that the presence of osmophobia during the headache attack had low sensitivity and negative predictive value, along with high specificity and high positive predictive value for the diagnosis of migraine among children and adolescents.

These findings were in line with a previous study completed by the same group among adults seen in a primary care setting.

While osmophobia was included in the appendix of the second edition of the International Classification of Headache Disorders, it was later withdrawn from the diagnostic criteria of migraine in the third edition of the algorithmic system. The study researchers supported a suggestion by Dr. Silva-Neto to further assess the utility of osmophobia as part of the diagnostic criteria of migraine.

Study researchers used a previously suggested criterion of nausea and/or vomiting, photophobia and phonophobia, and osmophobia during headache to identify migraine. They included 81 patients with probable migraine. Findings showed that a total of 6 children (7.4%) were diagnosed with migraine without aura. No patients diagnosed with tension-type headache changed their diagnosis.

“[W]e believe that the inclusion of osmophobia in the diagnostic criteria for migraine is useful for diagnosing migraine among children and adolescents,” concluded the study researchers.


Rocha-Filho PAS, Bernardo AAO. The usefulness of osmophobia for the diagnosis of migraine in children and adolescents. Headache. Published online July 4, 2021. doi:10.1111/head.14175