Increased Blood Flow Velocity in Middle Cerebral Artery and Headache Upon Ingestion of Ice Water.

Ole Hensel,Stephan Mages,Torsten Kraya,Philipp Burow,Andreas Wienke,Stephan Zierz

doi:10.3389/fneur.2019.00677

Ole Hensel, Stephan Mages + Show 4 more

Open Access

https://doi.org/10.3389/fneur.2019.00677

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Abstract

Introduction: “Headache attributed to ingestion or inhalation of a cold stimulus” (HICS) is one of the most common primary headache disorders. Little is known about the pathophysiology of HICS and other headache disorders. The aim of this study was to analyze mean flow velocity (MFV) and cerebrovascular resistance (RI) in both middle cerebral arteries (MCA) upon ingestion of ice water.Methods: The MFV and RI in both MCAs was continuously measured by transcranial sonography. HICS was induced by drinking 200 ml of ice water.Results: In all volunteers, the ingestion of ice water led to a decrease in RI, which was accompanied by an increase in MFV. In volunteers with induced HICS, MFV were significantly higher compared to volunteers that did not experience HICS. In volunteers with HICS, MFV increased even more significantly when lacrimation occurred compared to volunteers in which it did not. In volunteers without induced HICS, MFV was higher in those volunteers with a positive history of HICS than in those with a negative HICS history.Conclusion: This study revealed a raised MFV upon ingestion of ice water. Volunteers with a provoked case of HICS had a higher MFV than volunteers without HICS. The increase in MFV was even higher when the headache was accompanied by lacrimation. This may indicate an involvement of the trigeminal-parasympathetic vasodilator reflex.

Highlights

Headache after ingestion of a cold stimulus (HICS) is colloquially called an ice cream headache
No HICS or eye tearing was provoked by this stimulus
There was no difference between resting period and luke-warm water ingestion in terms of mean flow velocities (MFV) and RI (2.8 ± 8.8%; −5.1 ± 8.0%; both p > 0.05)

Summary

Introduction

Headache after ingestion of a cold stimulus (HICS) is colloquially called an ice cream headache. The recent International Headache Classification (ICHD-3, 4.5.2) describes this as a “short-lasting frontal or temporal pain, which may be intense, induced in susceptible people by passage of cold material (solid, liquid, or gaseous) over the palate and/or posterior pharyngeal wall” [1]. The prevalence of HICS in students is 62% and decreases in adults to 22–36% [3]. The experimental stimulation of the trigeminal nerve due to the ingestion of an ice cube, provoked a headache in 17% of healthy adults, in 23–32% of patients with tension-type headache and in 48–74% of patients with migraine [4, 5].

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