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Cold stimulus headache

Ivan Garza, MD
Section Editor
Jerry W Swanson, MD, MHPE
Deputy Editor
John F Dashe, MD, PhD


Cold stimulus headache, also known as ice-cream headache or brain-freeze headache, is triggered by exposure of the unprotected head to a cold environment, or by ingesting cold materials that pass over the palate and posterior pharynx.

This topic will review cold stimulus headache. Other types of headache are reviewed elsewhere. (See "Evaluation of headache in adults" and "Headache in children: Approach to evaluation and general management strategies".)

Cranial neuralgias and central causes of facial pain are discussed separately. (See "Overview of craniofacial pain" and "Central neuropathic facial pain" and "Nervus intermedius neuralgia" and "Nummular headache" and "Occipital neuralgia" and "Trigeminal neuralgia".)


The pathophysiology of cold stimulus headache is not completely understood. Cold temperature seems to be a trigeminal trigger [1] that is followed by possible reflex vasoconstriction [2].


In a Danish cross-sectional general population survey of people 25 to 64 years old, the lifetime prevalence of cold stimulus headache was 15 percent [3], while a survey of 13 to 15 year old adolescents from Taiwan found a prevalence of 41 percent [4]. Some studies [2,4-6], but not all [7], suggest that cold stimulus headache is more common in migraineurs than in the general population. A familial predisposition is suggested by the results of a cross-sectional epidemiologic study of students (age 10 to 14 years) from Germany, which found that the risk of cold stimulus headache was increased for children whose mother (odds ratio [OR] 10.7) or father (OR 8.4) had cold stimulus headache [8].

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Literature review current through: Nov 2017. | This topic last updated: Apr 13, 2017.
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  1. Cheshire WP. Headache and facial pain in scuba divers. Curr Pain Headache Rep 2004; 8:315.
  2. Boes CJ, Copobianco DJ, Cutrer FM, et al. Headache and other craniofacial pain. In: Neurology in clinical practice, Bradley WG, Daroff RB, Fenichel GM, et al (Eds), Butterworth Heinemann, Philadelphia 2004. p.2055.
  3. Rasmussen BK, Olesen J. Symptomatic and nonsymptomatic headaches in a general population. Neurology 1992; 42:1225.
  4. Fuh JL, Wang SJ, Lu SR, Juang KD. Ice-cream headache--a large survey of 8359 adolescents. Cephalalgia 2003; 23:977.
  5. Selekler HM, Erdogan MS, Budak F. Prevalence and clinical characteristics of an experimental model of 'ice-cream headache' in migraine and episodic tension-type headache patients. Cephalalgia 2004; 24:293.
  6. de Oliveira DA, Valença MM. The characteristics of head pain in response to an experimental cold stimulus to the palate: An observational study of 414 volunteers. Cephalalgia 2012; 32:1123.
  7. Bird N, MacGregor EA, Wilkinson MI. Ice cream headache--site, duration, and relationship to migraine. Headache 1992; 32:35.
  8. Zierz AM, Mehl T, Kraya T, et al. Ice cream headache in students and family history of headache: a cross-sectional epidemiological study. J Neurol 2016; 263:1106.
  9. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33:629.
  10. Mages S, Hensel O, Zierz AM, et al. Experimental provocation of 'ice-cream headache' by ice cubes and ice water. Cephalalgia 2017; 37:464.
  11. Cheshire WP Jr, Ott MC. Headache in divers. Headache 2001; 41:235.