Ice cream headache--site, duration, and relationship to migraine

To examine the characteristics of cold-induced headaches in a group of migraine patients, to compare these with their usual migraine headaches and with cold-induced headaches in a control population.

Subjects completed a structured questionnaire recording previous headache history along with the characteristics of any headache produced during supervised palatal and pharyngeal application of ice cream.

70 consecutive patients attending the City of London Migraine Clinic, and 50 pre-clinical medical and dental student volunteers from Queen Mary and Westfield College.

27% of the migraine patients and 40% of the students reported previous ice cream headaches. 17% of the migraine patients and 46% of the students developed headache following palatal application or a swallow of ice cream. Typically the headache was of early onset (x = 12.5s) and short duration (x = 21s), with a tendency for anterior headache on the same side as a palatal stimulus, and bilateral headache following an ice cream swallow. However, a significant minority experienced a previously unreported headache of late onset (x = 102s) and long duration (x = 236s) which tended to occur particularly after swallowing ice cream and to be less well localised to the side of the cold stimulus. Ice cream appeared not to be a common trigger for migraine, and there was no significant correlation between site of ice cream headache and usual site of migraine.

These findings confirm that cold stimulation of the palate or pharynx commonly produces a headache. In contrast to previous studies, our results suggest that the 'ice cream headache' is less common in migraine patients than the general population. A similar pattern of headache was produced in both migraine patients and controls, and apart from the few for whom an ice cream headache may trigger a migraine, the ice cream headache seems not to have any special significance for migraine patients.