Olfactory Hallucinations Leading to Weight Loss in a Patient with Migraine

Olfactory auras, in the form of hallucinations or phantosmia without an actual stimulus, have been very rarely reported in patients with migraine. This case report aims to raise awareness by presenting a patient whose condition was delayed in diagnosis, resulting in significant weight loss.

An 18-year-old female presented with complaints of a foul smell sensation that began a year ago, followed by headaches, loss of appetite, and weight loss. The patient experienced a sensation of rotting and burnt plastic odors lasting 2-12 hours, followed by severe, widespread throbbing headaches lasting 2-6 hours. Her past medical history was unremarkable, and her physical examination was within normal limits. Laboratory tests showed low vitamin D3 levels and low-positive nonspecific antinuclear antibody (ANA) titers. Electroencephalography (EEG) was normal, and brain magnetic resonance imaging (MRI) revealed a few millimetric nonspecific ischemic gliotic foci without other abnormalities. Otorhinolaryngology (ENT) and psychiatric evaluations were unremarkable. The patient's symptoms were largely controlled with lamotrigine treatment.

Due to the rarity of olfactory hallucinations in migraine attacks, patients may experience delays in obtaining an accurate diagnosis and management. Increasing clinical awareness of this rare presentation is therefore of paramount importance.