Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2016-10-20T11:59:35Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Tese Doutorado_Raimundo Pereira da Silva-Néto.pdf: 12833897 bytes, checksum: 61d0b7e980e72887cfbdb059a1866d40 (MD5) / Made available in DSpace on 2016-10-20T11:59:35Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Tese Doutorado_Raimundo Pereira da Silva-Néto.pdf: 12833897 bytes, checksum: 61d0b7e980e72887cfbdb059a1866d40 (MD5) Previous issue date: 2016-04-01 / Cefaleias primárias são decorrentes de disfunção cerebral e incluem migrânea, cefaleia do tipo tensional, cefaleias trigêmino-autonômicas e outras. Diversos fatores podem desencadear crises de cefaleia, mas os odores, especialmente o perfume, estão associados à migrânea. Objetivos: Caracterizar a estimulação olfatória como fator desencadeante de crises de cefaleia e de diferenciação entre migrânea e outras cefaleias primárias. Sujeitos e Métodos: O estudo foi prospectivo, experimental, randomizado com comparação de grupos, realizado no período de março a junho de 2015. Foram convidados 158 voluntários (73 homens e 85 mulheres) diagnosticados com cefaleias primárias, de acordo com os critérios da International Classification of Headache Disorders, Third Edition (beta version) (ICHD-3β). O estudo foi realizado por dois examinadores; atribuiu-se ao primeiro, diagnosticar a presença e o tipo de cefaleia primária, enquanto o segundo foi responsável pela exposição dos voluntários ao odor e pelo registro dos efeitos dessa exposição. Resultados: Dos 158 voluntários com cefaleia, houve 72 (45,6%) casos de migrânea e 86 (54,4%) com outras cefaleias primárias. Dos 72 migranosos, 53 (73,6%) eram mulheres e 19 (26,4%), homens e dos 86 casos de outras cefaleias primárias, 32 (37,2%) eram mulheres e 54 (62,8%), homens. A idade dos voluntários com migrânea e com outras cefaleias primárias foi, respectivamente, 22,5±3,10 e 22,9±3,10 anos. Essas diferenças não foram significantes (tmédias=0,666; p=0,566). Nos dois grupos, houve diferença nas características da cefaleia (c2=4,132; p=0,046). O odor desencadeou cefaleia (25/72; 34,7%) e náusea (5/72; 6,9%) apenas nos voluntários com migrânea, correspondendo a 19,0% (30/158) da amostra e em nenhum com outras cefaleias primárias (χ²=43,78; p<0,001). A cefaleia ocorreu mais frequentemente associada à náusea (p=0,146) e de localização bilateral (p=0,002) nos migranosos que apresentaram cefaleia desencadeada por odor. A cefaleia foi desencadeada após 118,0±24,6 min e a náusea após 72,8±84,7 min da exposição ao odor. Conclusões: O odor desencadeou crises de cefaleia ou náusea apenas nos pacientes com migrânea. Portanto, cefaleia desencadeada por odores poderá ser considerada um fator de diferenciação entre migrânea e outras cefaleias primárias e esse gatilho parece muito específico da migrânea. / Primary headaches are due to brain dysfunction and include migraine, tension-type headache, trigeminal autonomic cephalalgias and others. Several factors can trigger headache attacks, but odors, especially perfume, are associated with migraine. Objectives: To characterize the olfactory stimulation as a trigger of headaches and differentiation of crises between migraine and other primary headaches. Subjects and Method: The study was prospective, experimental, randomized with comparison of groups and conducted from March to June 2015. One hundred fifty-eight volunteers (73 men and 85 women) were diagnosed with primary headaches, according to criteria of the International Classification of Headache Disorders, third edition (beta version) (ICHD-3β). The study was conducted by two examiners and assigned to the first to diagnose the presence and type of primary headache, while the second was responsible for exposing the volunteers to odor and the recording the effects of this exposure. Results: Of the 158 volunteers with headache, there were 72 (45.6%) cases of migraine and 86 (54.4%) with other primary headaches. Of the 72 migraineurs, 53 (73.6%) were female and 19 (26.4%) male and 86 cases of other primary headaches, 32 (37.2%) were female and 54 (62.8%) male. The age of subjects with migraine and other primary headache was, respectively, 22.5 ± 3.10 and 22.9 ± 3.10 years. These differences were not significant (tmean=0.666; p=0.566). In both groups, there were differences in headache characteristics (c2=4.132; p=0.046). Headache attacks (25/72; 34.7%) and nausea (5/72; 6.9%) were triggered only in subjects with migraine, corresponding to 19.0% (30/158) of the sample, but in no with other primary headaches (χ²=43.78; p<0.001). Headache occurred more often associated with nausea (p=0.146) and bilateral location (p=0.002) in migraineurs who had headache triggered by odor. Headache was triggered after 118.0±24.6 min and nausea after 72.8±84.7 min of exposure to odor. Conclusions: The odor triggered headache attacks or nausea only in migraineurs. Therefore, headache triggered by odors may be considered a factor of differentiation between migraine and other primary headaches and this trigger seems very specific of migraine.

Background: Sensitization to sensory stimuli is an essential feature of migraine attacks. The relationship between the clinical course of migraine and increased sensitivity to olfactory stimuli has been little studied so far. - Methods: We analyzed the frequency and quality of osmophobia depending on the phase of migraine in patients with episodic and chronic migraine treated in an tertiary headache center with regard to gender, age, medical history and migraine disability assessment score (MIDAS). Standardized diagnostic questions were used for the assessment of osmophobia. - Results: In our cross-sectional investigation (n = 113), 38.1% of the patients showed an increased preictal hypersensitivity to odors, whereas 61.9% described ictal and 31.9% interictal hypersensitivity to odors, odor-triggered migraine was described in 30.1%. Median migraine disease duration has been statistically significantly longer in patients who suffered from interictal hypersensitivity to odors (28.5 years vs. 20 years; p = 0.012). There was a significant correlation between interictal hypersensitivity and higher age (54.50 vs. 45; p = 0.015). Patients with higher migraine disability in MIDAS experienced more frequently preictal and interictal olfactory sensitization and odor triggered migraine attacks. - Conclusions: In patients with longer migraine disease duration and higher migraine-related impairment, osmophobia was more frequently observed. These results might support the hypothesis of increasing sensitization with increasing burden of migraine.