cold-stimulus headache (brain freeze)

Epidemiology

• occurs in 1/3 of population
• may be more frequent in individuals with migraine

Pathology

• when cold liquid touches the hard palate, temperature sensors in the sphenopalatine ganglion cause blood vessel dilation, a response to increase heat delivery to the brain
• the blood vessel dilation produces the headache

Clinical manifestations

• headache a few seconds afer eating cold/frozen food(s)
  • peak sensation usually in 30-60 seconds
• duration is generally about 10-30 seconds after cold stimulus removed, but may last 2-5 minutes
• headache is generally mid-frontal, but may be temporal or retro-orbital (unilateral)
• may occur more frequently, if not exclusively in warm weather
• toothache may occompany headache

Management

• eat/drink cold items slowly
• avoid contact of cold items with hard palate
• a sip of warm beverage may hasten relief
• pressing tongue to roof of mouth may hasten relief

More general terms

• headache