Migraine With Exclusive Olfactory Aura: Case Report and Literature Review

To report the case of a patient enduring migraine attacks preceded by hallucinatory olfactory symptoms, with characteristics which typically define migraine with aura (MWA).

MWA accounts for about 30-40% of the total cases of migraine and is almost always preceded by visual disorders; and in rare cases migraine attacks are preceded by olfactory hallucinations which have not been so far recognized as a type of aura.

We describe a 51-year-old male whose migraine attacks are preceded, unusually for migraine sufferers, only by olfactory hallucinations; in 10% of the attacks, the olfactory symptoms are not followed by any pain but always appear with the same characteristics. These hallucinations began with the onset of a history of cephalea.

This case suggests that olfactory hallucinations should be considered as actual pre-migraine symptoms, like visual symptoms or other disorders, and added to the criteria for the diagnosis of MWA.