Fibromyalgia (FM) and migraine are common chronic disorders that predominantly affect women. The prevalence of headache in patients with FM is high (35%-88%), with migraine being the most frequent type. A particular subgroup of patients with FM (approximately half) presents with a combined clinical form of these two painful disorders, which may exhibit a different manner of progression regarding symptomatology and impact on daily activities. This article reviews several common aspects of the pathophysiology regarding pain control mechanisms and neuroendocrine dysfunction occurring in FM and migraine, particularly in the chronic form of the latter. We also discuss the participation of hypothalamic and brainstem centers of pain control, the putative role played by neurotransmitters or neuromodulators on central sensitization, and changes in their levels in the cerebrospinal fluid. Understanding their mechanisms will help to establish new treatment strategies for treating these disabling brain disorders.

Chikungunya virus is capable of affecting the nervous system of children and adults. We describe a case of sepsis and encephalitis triggered by this agent in a newborn whose mother developed symptoms of acute infection 2 days before delivery. Consequently, the infant had severe encephalitis that evolved with postnatal-onset microcephaly, bilateral optic atrophy, epilepsy and cerebral palsy.

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Objective.-The objectives of this study are to study osmophobia and odor-triggered headaches among headache pediatric patients.Background.-Achieving the correct diagnosis for headaches in younger children can be challenging. The presence of osmophobia could constitute a helpful piece of information for making the correct diagnosis of headaches among adults.Methods.-This was a cross-sectional study. Children and adolescents with headaches who were seen consecutively at a pediatric outpatient service and had at least 1 headache attack over the previous 12 months were included. We used a semi-structured questionnaire, Pediatric Migraine Disability Assessment, State-Trait Anxiety Inventory, and Children's Depression Inventory.Results.-About 300 patients were included; 253 had migraine, 47 had a tension-type headache; 137 had osmophobia during headaches (135 were migraineurs). "Osmophobia during headaches" for diagnosing migraine: Sensitivity: 54.4% (95% CI: 48.2%-60.5%); specificity: 95.8% (95% CI: 85.8%-98.8%); positive predictive value (PPV): 98.5% (95% CI: 94.8%-99.6%); negative predictive value (NPV): 28.5% (95% CI: 22.0%-36.0%). Osmophobia was associated with higher intensity (OR: 2.90; 95% CI: 1.63, 5.15; P < .001) and duration of the headache (OR: 5.73; 95% CI: 2.29, 14.3; P < .001) and with vomiting (OR: 3.56; 95% CI: 1.83, 6.96; P < .001) (logistic regression). There were 62 patients (all of them migraineurs) with odor-triggered headaches: sensitivity for diagnosing migraine: 24.9% (95% CI: 19.9%-30.6%); specificity: 100% (95% CI: 92.4%-100%), PPV: 100% (95% CI: 94.8%-100%), NPV: 20% (95% CI: 16%-26.0%). Odor-triggered headaches were associated with higher intensity (OR: 3.47; 95% CI: 1.64, 7.35; P = .001) and duration of the headache (OR: 3.28; 95% CI: 1.37, 7.86; P = .001), vomiting (OR: 2.37; 95% CI: 1.19, 4.74; P = .014), and phonophobia (OR: 2.40; 95% CI: 1.08, 5.32; P = .031) (logistic regression). Osmophobia was associated with higher-impact migraine (OR: 4.65; 95% CI: 1.30, 16.6; P = .018) and emergency care (OR: 4.65; 95% CI: 1.81, 12.0; P = .001) (logistic regression).Conclusions.-Osmophobia and odors as triggers for headaches are useful in diagnosing migraine and are markers for the severity of migraine in the pediatric population. Abbreviations: NPV negative predictive value, PedMIDAS-BP Brazilian version of the Pediatric Migraine DisabilityAssessment, PPV positive predictive value (Headache 2020;60:954-966) Headache