4.3: Cold stimulus headache

This headache is also known as ice cream headache. As pointed out by Raskin, eating cold ice cream quickly or gulping ice drinks may result in a temporary head pain which is characteristically bifrontal and quite severe and is said to be more apt to occur if one has already over-heated following exercise or hot temperatures. Pain reaches a crescendo 25 to 60 seconds after exposure to cold stimulus and is reported as a constant non-pulsatile deep pain. While most patients report mid-frontal discomfort, it may appear bitemporally, occipitally, generally or even unilaterally. Total duration of pain is several seconds to a minute or two. Mumford (1979) reported that there is a fall in skin temperature of 1 C at the forehead.

Raskin and Knittle (1986) indicated that in a randomly selected population, ice cream headache occurs in approximately one-third almost always as an infrequent and mild phenomenon. Among a population of migraineurs, over 90 percent reported ice cream headache. Wolff (1943-44) developed an experimental model of ice cream headache with the application of crushed ice to the roof of the mouth. This produced frontal pain and application of the crushed ice to the posterior pharynx produced retroauricular pain. No pain occurred when ice was applied to the gastric or esophageal walls. Wolff and Hardy (1941) experimented with cold induced pain by immersing volunteers’ hands into cold water. This produced a deep, aching sensation reaching a maximum pain in 60 seconds.

Raskin indicated that the vascular reaction to cold in patients with erratic vasomotor regulation, such as migraine, may be excessive. Ice cream headache may be no more than an epitome of the migraine mechanism. He suggests that migraine is a disorder of thresholds to a variety of stimuli. In his view, we are all probably capable of experiencing a vascular headache, given an appropriately intense stimulus. Some of us have thresholds so low that the ordinary stimuli of daily life trigger headache; this condition aptly describes the nature of migraine. Other probably analogous "threshold" vascular headaches include those resulting from fever, the inhalation of organic solvents, exposure to glare, and the ingestion of certain foods (Raskin, 1988). It has now been well-documented that massage over the carotid bifurcation can relieve most ice cream headaches within seconds.

It appears there is a ready therapy for most patients with ice cream headache. Moderate massage over the carotid bifurcation, unilaterally or bilaterally, can virtually instantly relieve the pain of ice cream headache.



 

 

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