The characteristics of head pain in response to an experimental cold stimulus to the palate: An observational study of 414 volunteers

Cephalalgia. 2012 Nov;32(15):1123-30. doi: 10.1177/0333102412458075. Epub 2012 Aug 21.


Objective: The objective of this article is to study the characteristics of headaches following an experimental cold stimulus and evaluate whether the ICHD-II criteria for headache attributed to ingestion or inhalation of a cold stimulus (HICS) are adequate for the diagnosis of the headache induced by ice on the palate area (ice-induced headache (IH)).

Results: One hundred and fifty-three out of 414 (37.0%) individuals tested had IH, but only 77/153 (50.3%) satisfied the ICHD-II criteria. The frontal (60.8%) and temporal (48.4%) areas were the most affected ones, with bilateral (77.1%) predominance, often of the pulsatile type (41.2%). One hundred and forty-seven out of 379 (38.8%) individuals who presented with a previous history of primary headache presented with IH, while only six out of 35 (17.1%) who had no history of previous headache reported pain in the test (OR 3.063, 95% CI 1.241-7.557). The ice-induced headache test was positive in 115/240 (47.9%) of the migraine sufferers and in 32/139 (23%) of the tension-type headache sufferers (OR 3.076, 95% CI 1.924-4.918).

Conclusion: IH is predominantly frontotemporal, bilateral and throbbing, most commonly affecting migraine sufferers, and the ICHD-II criteria are insufficient for classifying all individuals. We should, however, recommend caution regarding such a generalization from our findings with experimentally provoked cold stimulus headache to cold stimulus headache in general (i.e. HICS, ICHD-II).

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Brazil / epidemiology
  • Child
  • Cold Temperature*
  • Female
  • Headache / diagnosis*
  • Headache / epidemiology
  • Headache / physiopathology*
  • Humans
  • Ice
  • Male
  • Middle Aged
  • Palate / physiopathology*
  • Physical Stimulation
  • Prevalence
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Young Adult


  • Ice