Ice cream headache

BMJ 1997; 314 doi: http://dx.doi.org/10.1136/bmj.314.7091.1364 (Published 10 May 1997)
Cite this as: BMJ 1997;314:1364

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Ibn-e- Sīnā known to the West as Avicenna (b: 980 AD, Afshana near Bukhara— d:Hamedan, 1037 AD) was one of the most outstanding and influential Persian physicians and philosophers (1). He wrote more than 450 treatises on medicine, philosophy, religion and logic. Al-Qanun-fi-al-Tibb (The Canon of Medicine) is the most famous work among Avicenna’s medical books. He categorized diseases in the Canon of Medicine based on organ-based arrangement (2,3). Neurologic diseases chapter is an attractive and detailed part of this book. One of the most important parts of neurologic chapter allocated to headache (Soda'). He mentioned several types of headache and discussed about a type of headache that named Soda' Sāzej Bāred (4). Sāzej means simple and points to a disease that often is due to an obvious external factor (like malodorous smells or living in a noisy place). Bāred means cold and reflects this point that trigger factor is a cold thing (like eating a cold food). So we can say that Ice cream headache, from Avicenna’s viewpoint, is an example of Simple Cold headache. 1. Gorji A., Khaleghi Ghadiri M. History of epilepsy in Medieval Iranian medicine. Neurosci Biobehav Rev. 2001 Jul;25(5):455-61. 2. Zargaran A., Mehdizadeh A., Zarshenas MM., Mohagheghzadeh A. Avicenna (980–1037 AD). J Neurol. 2012 Feb;259(2):389-90. 3. Tabei SZ., Riazi A., Medical Sciences in the Third Millennium: An Avicennian Approach. Iran Red Crescent Med J. 2009;11(1):4-9. 4. Avicenna, The Canon (Persian translation), 3rd edition. Tehran: Ministry of Health and Medical Education of Iran, Committee of Computerizing Medicine and Hygiene, 2007.

Competing interests: None declared

Mohammad Hashem Hashempur, Ph.D student

Heydari M.

Research center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

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27 April 2008

I have gotten ice cream backaches my whole life and never understood the concept of a "brain freeze."

I got a lot of goofy looks when I wold wiggle and squirm to try to get rid of the backache I'll tell you, and as a kid that has something happen to them that happens to no one else, you can guess that it was a source of ridicule.

I'm not the only one I know that gets backaches, but the other two are my mother and sister, and at that, my sister alternates between a headache and a backache.

My brother gets headaches, though. Maybe it's a latent trait of some variety. If it were simply a vaso-constriction in the brain or cold traveling through your blood stream, the response would be 100%. However, it wasn't 100% even in the migraine group. My thought, based on my experience with my immediate family having the problem, is that there is a chromosome that triggers the effect of the Ice Cream Headache, and another to show where it is.

Competing interests: None declared

Competing interests: None declared

Thomas L Strizek, Utility Locator

SM&P Utility Resources

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I believe that the 'brain freeze' could be caused by referred pain due to stimulation of pain receptors in the palette. These receptors may propogate action potentials along non-myelinated fibres, accounting for the latency before the pain is felt.

Nociceptors (pain receptors) do not show a short-term adaptive response, and this could explain why the pain does not seem to dissapate until the palette is warmed again (by the toungue etc.). Also, the pain I feel when experiencing a brain freeze reminds me of that experienced when eating horseradish or wasabe. Both of which contain isothiocynates, which activate the receptor responsible for painful cold sensation.

The pain felt in the throat and stomach reported by some people could simply be a result of quickly swallowing the cold substance so it is still cold when reaching the throat and passing through the thorax.

This is merely speculation and I apologise if I have stated anything incorrectly.

Competing interests: None declared

Competing interests: None declared

David Franks, Student

Cambridge University

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i find that when ice cream comes into contact with the roof of the mouth and the back of the throat a temporary brain freze results that, if endured, will end in a few seconds. However, I also find that anything you ingest warmer than the ice cream quickly reverses the problem.

Competing interests: None declared

Competing interests: None declared

charles n douglas, small business owner

5683 whale watch st., las vegas nv. 89113

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11 August 2004

I really don't understand why people want to get rid the "brain freeze" so fast. the longest one i have had lasted only 10-15 seconds, and quite honestly i like them. They happen very rarely to me but the feeling of the pain makes me think of being little again. After a quick shake of the head, which does absolutely nothing, the pain dissipates and i go back to eating the ice cream. Does anyone else enjoy the pain because of an association or because "It hurts sooo good?"

Competing interests: Oatmeal

Competing interests: None declared

Pita Mahn, Food Service

60625

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This is an intriguing problem. Two observations come to mind. The first was a man in his forties with hypertension who had a coeliac axis stenosis and who developed abdominal pain whenever he drank cold water (1). His pain was accompanied by a gastric intramucosal acidosis, which would appear in my current thinking to be caused by the rate of energy release by ATP hydrolysis that exceeds the rate at which ATP is resynthesised by oxidative phosphorylation. Revascularisation eliminated the the intramucosal acidosis and like the other patients studied appeared to eliminate his symptoms but these patients are notoriously difficult to evaluate. Food of course is the usual stimulus. Another investigator has comfirmed our provocative findings (2).

One mechanism by which intragastric stimuli might cause abdominal pain is by causing vascular or smooth muscle muscle spasm. Another mechanism is by causing a steal of blood flow from a midgut supplied by stenotic mesenteric arteries (3,4,5). Neither of these would seem to account for an ice cream headache (6). A haematogenous or neural/humoral reflex needs to be invoked.

A decrease in temperature causes a rise in pH by a purely physical effect (7). If high enough it will inhibit oxidative phosphorylation by eliminating the protonmotive force driving ATP resynthesis by oxidative phosphorylation. In so doing it might increase the [ADP] and induce a haemotological changes such as activation of the ADP receptors on platlets (8). Cold is known to cause cryoprecipitation of blood products in some patients.

As the supply of oxygen is not inhibited in these circumstances the stage may be set for free radical release upon rewarming. In which case a bolus of free radicals might be released not only into portal venous blood but also into gastric lymphatics and have direct access to the brain by draining into the thoracic duct. Perhaps this caused the ice cream headache.

The release of free radicals upon reperfusion has been implicated in the causation of pain (9). Furthermore the free radical release induced by reperfusion after a transient fall in gastic intramucosal pH has been implicated in multiple organ dysfunction (10). Neurological ddysfunction appears to be the most sensitive symptomatic measure of multiple organ dysfunction in awake patients(11).

Sir Thomas Lewis brought the scientific method to the investigation of human disease at the bedside when he was at Univeisty College. In 1927 he described the triple response to a cutaneous njury, flush(redline), flare(red zone) & weal(edema), and the classic five signs - rubor(redness), tumor(swelling), calor(Heat), dolor (pain) and loss of function of inflammation are well known. It starts with dilatation of blood vessels(vasodilatation) to bring more blood (Hyperemia) and along with it the mediators of defence & healing. Blood vessels become leaky allowing escape of fluids(transudation), proteins & cells (exudation) into tissue space causing edema. The WBC crawl out of capillary(emigration) towards site of injury attracted by chemicals(Chemotaxis) and engulf debris (phagocytosis). Antibodies and other chemical mediators of inflammation serve to neutralise the injurious agents such as microbes.

If one thinks about cutaneous injury, which contrary to visceral injury is painful, it occurs in an hyperoxia, hypocarbic environment. This should inhibit oxidative phosphorylation by elevating the pH and thereby presumably prevent the generation of free radicals until reperfusion when it could be excessive. If blood flow is compromised at first from vasocontriction and platelet plugging coling should also occur compounding thelevation in pH in increasing the need for an exothermic metabolic response, one that iappears to occur with anaerobic glycolysis. The lumen of the gut is, in contrast, microaerophilic. It has a very low pO2, relative to air, and a pCO2 the same as that in arterial blood or a little higher on occasions. These are not circumstances in which free radicals should be produced in anything like the amount presumabky seen after, for example, removal of a colonic polyp. The difference might account in part for the difference in pain experienced.

The release of free radicals upon reperfusion might be responsible for the initial pain experienced in the triple and for an ice cream headache, the latter being a systemic and the former a local manifestation. The pain associated with the later inflammatory response might be a regional manifestation.

If in the evolution of man avoiding the toxic effects of oxygen has been a crucial property then, thinking in terms of a simple cellular automata or Wolfram rule(12), pain is a likely derivative. It is not a response that would have included a nervous system until evolution was far advanced.

1. Fiddian-Green RG, Stanley JC, Nostrant T, Phillips D. Chronic gastric ischemia. A cause of abdominal pain or bleeding identified from the presence of gastric mucosal acidosis. J Cardiovasc Surg (Torino). 1989 Sep-Oct;30(5):852-9.

2. Faries PL, Narula A, Veith FJ, Pomposelli FB Jr, Marsan BU, LoGerfo FW The use of gastric tonometry in the assessment of celiac artery compression syndrome. Ann Vasc Surg. 2000 Jan;14(1):20-3.

3. Poole JW, Sammartano RJ, Boley SJ Hemodynamic basis of the pain of chronic mesenteric ischemia. Am J Surg. 1987 Feb;153(2):171-6.

4. Boley SJ, Brandt LJ, Veith FJ, Kosches D, Sales C A new provocative test for chronic mesenteric ischemia. Am J Gastroenterol. 1991 Jul;86(7):888-91.

5. Fiddian-Green RG. Provocative test for chronic mesenteric ischemia. Am J Gastroenterol. 1992 Apr;87(4):543

6. Joseph Hulihan Ice cream headache BMJ 1997; 314: 1364

7. JOHN W. SEVERINGHAUS, POUL ASTRUP, and JOHN F. MURRAY Blood Gas Analysis and Critical Care Medicine. Am. J. Respir. Crit. Care Med., Volume 157, Number 4, April 1998, S114-S122

8. Herbert JM, Savi P. P2Y12, a new platelet ADP receptor, target of clopidogrel. Semin Vasc Med. 2003 May;3(2):113-22.

9. Xanthos D, Francis L, Bennett G, Coderre T. Animal Models of Chronic Pain: Chronic post-ischemia pain: A novel animal model of Complex Regional Pain Syndrome Type I produced by prolonged hindpaw ischemia and reperfusion in the rat. J Pain. 2004 Apr;5(3 Suppl 2):S1.

10. Nielsen VG, Tan S, Baird MS, McCammon AT, Parks DA Gastric intramucosal pH and multiple organ injury: impact of ischemia-reperfusion and xanthine oxidase. Crit Care Med. 1996 Aug;24(8):1339-44.

11. David Taggart About impaired minds and closed hearts BMJ 2002; 325: 1255-1256

12. Stephen Wolfram. A New Kind of Science. Wolfram Media, Inc., 2002.

Competing interests: None declared

Competing interests: None declared

Richard G Fiddian-Green, FRCS, FACS

None

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7 August 2004

Does anyone else feel an odd sort of pain, constricting breath when they eat lots of ice cream really fast? I do. I want an explanation.

Competing interests: None declared

Competing interests: None declared

Kaitlyn A. Coffey, Student

22560

Don't work

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7 August 2004

Ice cream does not induce a brain freeze in me, but it oftentimes induces farting, stomach ache, and head ache. I think this adds to our understanding, and extends the symptoms to include more than brain freeze. I wonder if the brain freeze subjects also have these symptoms, but perhaps out of embarassment are not willing to mention it. One doctor I saw suggested I had lactose intolerance, but another said he thought I did not. I recently underwent a Hida Scan which found that my gallbladder is functioning at a normal level, although in the lower part of the normal range. Perhaps this is analagous to people whose IQ range is dull normal.

Competing interests: Farting

Competing interests: None declared

Russell Eisenman, Assistant Professor of Psychology

University of Texas-Pan American, 78541

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7 August 2004

Ya dude, im only 14 but i was bored so i looked at this n i get that same stuff right behind my shoulder just like a brain feeze only the shoulder n it goes away in about 5 or 10 seconds

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Clint Walker, i skateboard?

the streets 78456

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7 August 2004

I enjoyed this article, I forwarded it to my husband, because it goes so in line with what I have been telling him about migranes for 10 years... I don't remember when my migranes started, I rembember when I was about 4 telling my parents that I had a tummy ache right here... and pointing to my head though. When I was little no one believed me about my head aches, and so I was sent to school, and struggled because I couldn't keep up because my head aches would get worse because of all the stimuli. Over the years, I learned how to deal with them, and by time I met my husband I had gotten to a point where my routines weren't so devastated all the time because of them... yes I still have them, and if left unattended, I still suffer them just as badly, but I don't let them get so bad now. I have found that by taking 2 tylenol, taking a hot shower (despite the temperatures), and drinking hot herbal tea, my pain would reduce greatly... Enough so that I wouldn't be seeing spotted vision, and throwing up,getting bloody noses and so forth... I could still function... I find that if I wear a stocking cap, and comfortable sweats I usually have an even better chance of eventually pulling out from the migrane all together, instead of going days with the pain... It doesn't always work, however, but it reduces it enough that I can still take care of our kids, and function with out breaking into tears, and sleeping my life away. my husband is not someone who really had any experience with head aches, so when we were first married, it was an adjustment for him, because he didn't know really what I was experiencing, so I told him that it felt like a head rush, or brain freeze, only it doesn't go away.. When he went to basic training, one of the girls in his Technical training class, experienced migranes, she had only been having them for a few years, but because of their situation in their training, she was really struggling to deal with them, so he told her what I did to control them, and she didn't try it at first, but one day in deperation, did... and he said she came out smiling and told him that it didn't get rid of it completly, however, it reduced it so much that she felt good again. At that point, I think my husband finnally started to realize that my descriptions, and self taught coping skills were something that seemed to have something to it... I always recomend seeing a dr. to get a full annalisis of any kind of medical concern, but I also tend to find that once people know that you are a migraine sufferer and that they see you out functioning dispite your pain, they become curiouse... There are alot of different triggers for migraines... and everyone is a little different. food and sinus irritation is only a few. I find that any time that my body seems to become over whellmed or I go to extremes, I usually end up with one... Over hungry or thirsty, over tired, extreme temperature fluctuation of over 20 degrees, over stressed, allergies, over or under activity, excessive noice, or light. I often wonder sometimes if the physical cause of the pain, isnt linked to something along the lines of chemical imballances, and just how the body reacts to that, or kind of like how thyroid function effects the body. The triggers, just seem to be the inital cause of the onsought, and that the reaction is a coping mechanism, and that there seems to be atleast for alot of my friends with migranes, actually avoidance and control treatments. I have one friend who is on blood pressure medication, and anouther who is on I believe heart medication, even though neither of them suffer symptoms of blood pressure problems, or heart conditions, the medications were perscribed to control the body's natural responses, to inhibit the pain... I myself am always right on close to perfect for my blood pressure, however I do find that sometimes I will go down just barely, not enough that my dr, hardly notices, I am still well in the target pressure rate, and even though I know body tempurature has been debated, and at various points thrown out back and forth with migrane studies. I do find that when I am experiencing migranes, I struggle to maintain body temperature, and that even if my body temperature does not go down, when I reduce my body's effort to maintain temperaute, I have better sucess at controlling the effects of the migranes. So I think there is some ground to what you are saying, I definatly concure with the findings of this report. Thanks for posting it! Sincerly, Karlene

Competing interests: None declared

Competing interests: None declared

Karlene markham, catering

CUSD

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