Cerebral vasoconstriction causing decrease in arterial flow may have role

Editor—Joseph Hulihan describes postulated mechanisms in the genesis of ice cream headache and its uncertain relation to migraine.1 Using transcranial Doppler ultrasonography, I have measured the middle-cerebral-arterial flow velocities in two subjects who developed a headache, and in one who did not, when they were eating ice cream. When the headache developed the mean flow velocities decreased from 72 to 58 cm/s and from 51 to 33 cm/s. There was no change in mean flow velocity in the subject who did not get a headache. Although the brain temperature was not directly measured, these observations suggest that cerebral vasoconstriction causing a decrease in flow may be important in the development of an ice cream headache. They do not shed light on whether the change in cerebral blood flow is mediated intracranially (due to an overreaction of a vasogenic reflex responding to a small drop in the temperature of the carotid blood) or is due to a reflex response triggered by the sensation of cold in the palate or oropharynx.

Ice cream headache occurred during surfing in winter

Editor—In his editorial on ice cream headache Joseph Hulihan referred to headaches developing within 20 seconds of ice cream being applied to the soft palate.1 In my wilder days as a winter surfer we all knew about the sickening frontal headache that resulted within seconds of driving through a breaking wave. The pain continued for 20 to 30 seconds, only to be reinforced by the next breaking wave. Even then (35 years ago) we always referred to the pain as the ice cream headache.

The speed at which the headache develops suggests that this is a cutaneous sensory response, rather than a change in temperature transmitted to the brain through the skull and meninges.