Osmophobia and Migraine

Medically reviewed by: Omid Moshtaghi, MD

Have you ever been overly sensitive to odors before, during, or after a migraine attack? You’re not alone! While sensitivity to light (photophobia) and/or sound (phonophobia) are well-known symptoms of migraine, increased sensitivity to scents, or osmophobia, is also very common—though it receives less attention.

What is Osmophobia?

Osmophobia is defined as “a fear, aversion, or psychological hypersensitivity to odors.”¹ For example, the normally pleasant smell of an air freshener might repulse you during a migraine attack. Along the same lines, another smell-related symptom called hyperosmia causes a physiological heightened sense of smell. In this case, you may find that your cleaning products smell stronger during an attack. Although hyperosmia and osmophobia have different definitions, you might see them used interchangeably when discussing migraine-related sensitivity to odors.

Osmophobia and Migraine

A variety of illnesses and conditions can cause osmophobia, but it’s extremely common in people with migraine disease. The “migraine brain” is inherently sensitive to sensory stimulation (ex. light, sound or touch). Sensitivity to smell is just another manifestation. 

You might experience osmophobia in different ways:

• Before a migraine attack—you experience a migraine attack soon after noticing that everyday odors seem stronger or more irritating than usual.
• During a migraine attack—you want to curl up in a dark, quiet room during an attack but the scent of your favorite fabric softener is suddenly intolerable.
• Between migraine attacks (the interictal period)—you become extra-sensitive to everyday odors in between migraine attacks.
• Around specific odors—you notice you’re extra-sensitive to certain scents (maybe one kind of strong food odor doesn’t bother you but another one does).

The most common olfactory offenders cited in studies are body perfumes, fragrances in scented candles/air fresheners, food, cigar or cigarette smoke, and cleaning products.² However, this varies from person to person and can be anything!

Impact of Osmophobia on Migraine

Estimates about the prevalence of migraine-related osmophobia before, during, or between attacks vary widely, from about 25% to over 80%.³ Studies have found that osmophobia is linked to more severe and longer attacks, a longer history of the disease in people with episodic migraine, allodynia, as well as higher levels of anxiety and depression.⁴

Osmophobia is likely caused by something called central sensitization.⁵ This is when the central nervous system (brain and spinal cord) becomes overly sensitive, which is thought to be the result of frequent or long-lasting migraine attacks. Experts believe central sensitization can contribute to the progression of episodic migraine to chronic migraine (15 or more headache days a month).

There may also be a correlation between osmophobia and allodynia, or pain from stimulation that normally is not painful.⁵ A person with migraine disease may say, “Even my hair hurts today,” and they may not be joking! Simple tactile stimulation like hair-brushing, touching your skin or clothing moving on the body can be painful for people with allodynia.

Trigger or Prodrome Symptom?

Do odors trigger your migraine attacks? Or are you more sensitive to odors before the headache phase of an attack? The answer may be complicated.

Existing studies have been inconsistent as to whether something is a trigger (ex. the smell of perfume causes an attack) or if a person is hypersensitive to smells because they are in the prodrome or first phase of a migraine attack. Recent imaging studies suggest that areas of the brain related to certain migraine symptoms are activated during the prodrome phase, which can begin up to 48 hours before the headache phase of the attack. 

It’s important to record in your migraine diary if you notice that you have an attack soon after exposure to or aversion to certain odors.

Coping With Osmophobia

Here are some tips for coping with migraine-related osmophobia:

1. Identify the culprits. Are the scents that bother you the most all in the same category, like “cooking smells” or “perfumed lotions and soaps”? Or are there a few scents scattered over different kinds of categories? Use your migraine diary to help you identify the worst offenders.
2. Use unscented products at home. Many household cleaners, health and beauty aids (ex. soaps, lotions, etc.), and other products often come in unscented formulas.
3. Get creative in avoiding odors. If certain food odors are your bad guys, limit your consumption of those foods. If others in your household cook items that bother you, see if you can work out a schedule to limit your exposure to those odors. You might schedule your errands for the time someone is cooking, or you could increase ventilation around the kitchen during and after cooking.
4. Go scent-free at work/school. Talk to your employer or school about adopting scent-free policies. Scent-free schools and workplaces are safer and more comfortable for many people, including those with allergies, epilepsy and other conditions.
5. Try using migraine-friendly scents. This one isn’t suitable for everyone, but some people with migraine find certain scents like peppermint or lavender soothing during attacks. 
6. Reuse the lessons from the COVID-19 pandemic. COVID-conscious practices are excellent for minimizing your exposure to infectious diseases AND scents that may trigger your migraine attacks. Improving indoor air quality (IAQ) through better ventilation and the use of HEPA filters or DIY air cleaners (like Corsi-Rosenthal boxes) may reduce the concentration of those scents in your environment. Wearing a respirator (like a KN95 or N95) can minimize your exposure when you can’t control your environment.
7. Talk to your healthcare provider about a comprehensive migraine treatment plan. Osmophobia is closely associated with progressing migraine disease. If you have osmophobia, or if it’s occurring more frequently, talk to your healthcare provider about a comprehensive regimen that could include preventive treatments, acute treatments, and lifestyle changes.

References

1.  Delussi, M., Laporta, A., Fraccalvieri, I. et al. Osmophobia in primary headache patients: associated symptoms and response to preventive treatments. J Headache Pain 22, 109 (2021). https://doi.org/10.1186/s10194-021-01327-2 
2.  Gossrau, G., Frost, M., Klimova, A. et al. Interictal osmophobia is associated with longer migraine disease duration. J Headache Pain 23, 81 (2022). https://doi.org/10.1186/s10194-022-01451-7 
3. Chitsaz, Ahmad; Ghorbani, Abbas; Dashti, Masoumeh^1,; Khosravi, Mohsen²; Kianmehr, Mohammadreza³. The Prevalence of Osmophobia in Migranous and Episodic Tension Type Headaches. Advanced Biomedical Research 6(1):p 44; 2012 | DOI: 10.4103/2277-9175.204587 https://journals.lww.com/adbm/fulltext/2017/06000/the_prevalence_of_osmophobia_in_migranous_and.44.aspx 
4. 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, https://doi.org/10.1093/pm/pnab314
5. Lovati C, Giani L, Capiluppi E, Preziosa G, D’Amico D, Mariani C. O067. Osmophobia in allodynic migraine: role of frequency of attacks and headache duration. J Headache Pain. 2015 Dec;16(Suppl 1):A104. doi: 10.1186/1129-2377-16-S1-A104. PMID: 28132284; PMCID: PMC4759273.