Abstract
Dear Sir We read with interest the recent report by Mattson (1) regarding the prevalence of headache caused by drinking cold water and would like to report an unusual case of cold-stimulus or ice cream headache.
A 48-year-old woman was referred for neurological assessment after she repeatedly experienced a headache while ice skating. Being a speed skater, she reported that she would breathe through her mouth when skating. The headache began while she was warming up and would worsen and persist during her training session. She described a sharp pain over the right maxilla, similar to that which she experienced on eating ice cream quickly. There were no other associated features. The pain abated when she finished skating and was not precipitated by anything else. There was no personal or family history of migraine. She had twice been reviewed by a dentist to exclude any dental pathology. A CT scan with contrast of the brain and sinuses was normal, as was her neurological examination.
Cold-stimulus headache has been reported to occur during surfing in winter (2) and is more frequent in migraineurs (1, 3). Its pathogenesis remains uncertain but may be related to the vasoconstriction induced by the cold stimulus or stimulation of cold receptors (4). The discomfort usually only lasts several seconds after the stimulus. Presumably the cold air above the ice rink, as it is inhaled through the mouth and passes over the palate, is the stimulus for this patient's pain. The pain appears to persist until the stimulus is removed, that is, the patient stops skating.