Phantosmia is a rare migraine aura. We present two cases of phantosmias occurring before migraine headaches and also without headaches. To our knowledge, these are the third and fourth cases of phantosmias ever reported due to migraine aura without headache.

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ObjectiveTo review our inpatient experience treating a variety of headache disorders with heterogeneous therapies and to determine outcomes and predictors of response.MethodsWe conducted an IRB-approved retrospective chart review of elective inpatient headache admissions from the Montefiore Headache Center from 2014-2018. We examined factors associated with response and outcomes at discharge and post-hospitalization follow-up in an intractable population. Patients received different classes of intravenous medications including anti-emetics, neuroleptics, dihydroergotamine, lidocaine, steroids, valproic acid (VPA) and nerve blocks, and home preventive medications were either continued or changed before discharge. Improvements were defined at discharge by headache intensity compared to prior to hospitalization.ResultsAmong the 83 admissions, pain improvement at discharge occurred in 90.4% (n=75) of the overall sample, 89.5% (n=60) of those with chronic migraine, 75.0% (n=9) of patients with NDPH, and 89.5% (n=34) of all those with acute medication overuse. Fifty-six patients (67.5%) reported improvement of a 3 or more point reduction in headache intensity at discharge, with a mean reduction of 4.84 +/- SD 2.51 (range 1-10). Of the 66 patients who received IV DHE, 59 (89.4%) of them improved at discharge. Of the 11 (13.2%) patients who received IV lidocaine, 7 (63.6%) improved. Of the 14 (16.9%) patients who received nerve blocks, all 14 (100%) improved at discharge. Of the 75 patients who had improved at discharge, 63 (84%) followed-up and 50 (79.4%) of those patients remained improved. At second follow-up, 68 (81.9%) patients returned for follow-up on average of 71 days (range 10-283) post-discharge.ConclusionOur inpatient headache experience featured numerous treatments with high rates of improvement in the short and intermediate term for all headache disorders. These results may suggest that stratified hospitalized care including polytherapy may be useful for many patients.