A Case of Osmophobia Associated with Migraine Improved with Kamishoyosan

Abstract

　Osmophobia is a sensory hypersensitivity characteristic of migraine, yet no established treatment is currently available. We report a case of a 49-year-old woman who developed severe osmophobia that markedly interfered with her daily life. She had a history of migraine, and for several years various odors triggered discomfort and nausea and occasionally precipitated migraine attacks. Physical examination revealed tenderness in the right hypochondrium together with anxiety, fatigue, shoulder stiffness, and constipation. Based on these findings, a Kampo pattern associated with emotional stress, autonomic imbalance, and impaired circulation was considered, and treatment with kamishoyosan was initiated at 7.5 g/day. After 12 weeks of treatment, the osmophobia index, derived from visual analogue scale scores for odor-related discomfort recorded in a headache diary, improved from 32 to 8. Avoidant behavior and odor-related anxiety also diminished, and monthly migraine days decreased from 5 to 2. This case suggests that kamishoyosan may represent a potential therapeutic option for osmophobia associated with migraine.