Perfume and other strong odors may trigger headaches and migraine episodes in some individuals. Some people may refer to them as “perfume-related headaches” or “olfactory migraine attacks.” Scientists are investigating why they occur.

A person’s sense of smell, or olfaction, is crucial for providing important sensory information in everyday activities like eating. For example, a person may be able to smell if leftover food has spoiled.

While some smells may be pleasant, others may cause physical reactions in some people, like headaches and nausea.

This article explores the link between perfumes and headaches, migraine and olfactory hallucinations, and when to speak with a doctor.

To discover more evidence-based information and resources for headache and migraine, visit our dedicated hub.

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Fragrances and perfumes comprise dozens of compounds or synthetic volatile chemicals that create an odor. Volatile means that they evaporate at room temperature.

Many studies show that fragrance compounds can cross the blood-brain barrier, which is a protective layer of blood vessels and tissues that surrounds the brain, and interact directly with receptors in the central nervous system.

Larger molecules in the bloodstream, including many medications, cannot cross the blood-brain barrier.

Fragrance compounds may also produce immediate changes in body functions, including blood pressure, brain activity, and pulse rate.

Some people may experience hyperosmia, which is a heightened sense of smell. This phenomenon may occur for a number of reasons, such as pregnancy, but scientists have a limited understanding of how and why it happens.

Fragrance sensitivity and allergic reactions

The National Eczema Association, suggests that fragrance sensitivity, which refers to sensitivity or allergic reactions to certain fragrances or perfumes, is present in 1–4% of the general population.

Meanwhile, an international 2019 study noted about one-third of adults across the United States, Australia, the United Kingdom, and Sweden report fragrance sensitivity.

Individuals with fragrance sensitivity reported various health effects upon exposure to fragranced products like perfume, air fresheners, and personal care products, including:

The authors of the study found that migraine episodes associated with fragranced product exposure occurred in 12.6% of the general population.

Osmophobia

Osmophobia, which experts define as fear, aversion, or psychological hypersensitivity to smell, is common among people with migraine.

According to the American Headache Society, aside from triggering migraine, osmophobia may also worsen a migraine episode. To add, those with osmophobia tend to have longer migraine duration and higher migraine-related impairment.

A 2016 study on 113 people noted that odors were a common trigger for migraine, affecting 90.2% of the study participants, with perfume odor being the most common trigger, followed by cleaning products, cigarette smoke, and motor vehicle exhaust.

More specifically, a 2017 study found that perfumes with floral scents commonly triggered migraine episodes.

Experts still do not know how odors trigger headaches, but some believe that the smells directly interact with the trigeminal nociceptive pathway. This is a sensory pathway along the nose and mouth and into the brain via the trigeminal nerve, which is one of the cranial nerves.

Others hypothesize that the scents trigger the release of inflammatory substances in the brain and cause pain.

It may also activate the trigeminovascular system and dural pain receptors, which lead to a state of reactivity that lowers the threshold for pain. This may also lead to allodynia, or the experience of pain from a stimulus that does not typically cause pain.

Learn more about migraine triggers here.

Olfactory hallucinations refer to the perception of a smell that does not exist in a person’s environment.

Experts estimate that olfactory hallucinations occur in about 0.1% of adults with migraine. According to an older 2014 study involving 537 children and adolescents with migraine, olfactory hallucinations appear to be more common during childhood, with a prevalence of 3.9%.

The true prevalence of olfactory hallucinations in migraine episodes (OHM) is unknown, but it is likely to be higher since people with migraine may find olfactory hallucinations less noticeable than visual hallucinations.

A 2022 case study reported two different presentations of olfactory hallucinations. One person reported smelling cigarette smoke from the beginning of her migraine episodes up to 3–7 days after the episodes subside.

The other person reported occasionally smelling a burning smell, either of trash or cigarettes, for around 30 minutes before experiencing a migraine episode.

According to a 2020 study, migraine is often not diagnosed correctly, and many individuals do not undergo appropriate treatment.

Additionally, according to the American Migraine Foundation, it is estimated that less than half of people with migraine seek medical help. It suggests that a person should talk with a doctor about their migraine if:

  • it interferes with their daily life and causes them to miss activities, school, and work
  • it causes a person to plan their lives around their migraine
  • it prevents a person from doing something they really want
  • a person has one or more migraine episodes on average per month
  • medications do not help
  • a person experiences frequent migraine episodes
  • a person self-medicates more than twice a week for migraine episodes and other types of headache

A doctor can help a person identify the possible causes of their migraine and potential triggers, such as perfumes and other odors so that a person can avoid them and prevent a migraine episode. A healthcare professional can also recommend appropriate treatment.

Perfume and other strong odors may trigger headaches, migraine episodes, and many other symptoms in some people.

Some individuals may experience fragrance sensitivity and research suggests that osmophobia is common among people with migraine. While rare, some people with migraine may also experience olfactory hallucinations.

A person experiencing frequent migraine symptoms that interfere with their daily life should speak with a doctor to determine possible causes and triggers of a migraine episode. A healthcare professional can also recommend appropriate treatment.