Friday Fun – The “Scoop” on Ice Cream Headaches

(And that’s the last pun for this week.)

It was last week in my post on Cats taking over a London tube station that I mentioned I try to shy away from the science/tech stuff, given they hold an inherent interest for me and I don’t want to favor that topic too much.  But Edie said she thought we’d enjoy them – so I’ll give it a go with a quickie one.

One in three of us (I was surprised that not everyone gets them) have suffered through what’s frequently called an Ice Cream Headache, Cold-Stimulus Headache, Trigeminal Headache or its given scientific name Sphenopalatine Ganglioneuralgia (meaning "pain of the sphenopalatine ganglion nerve").  Or more commonly – a Brain Freeze.

The term Ice Cream Headache first appeared in a manuscript by Rebecca Timbres on January 31, 1937 that was eventually published as book in 1939 with the snappy title of “We Didn't Ask Utopia: A Quaker Family in Soviet Russia”.  (With a title like that, is it any wonder it took her TWO YEARS to get the thing published?)

And while it’s been discussed in the medical literature since at least the 1850s, it wasn’t until 1988 that the International Headache Society formally recognized the malady, which they have labeled “Cold Stimulus Headache”.

CAUSATION

The phenomenon occurs about 10-20 seconds after too rapidly eating or drinking an extremely cold food – whereby it comes in contact with the soft palate, thereby inducing that sharp, stabbing, bi-frontal headache.  It usually only last 30-60 seconds, and never more than five minutes.  And fortunately it’s self-limited.

PATHOPHYSIOLOGY

Theory 1 – Trigeminal Nerve Factor

It long been known that when something cold contacts your palate, the sudden temperature change of the tissue stimulates nerves to cause rapid dilation of blood vessels in an effort to bring warm blood to the area.  This rapid dilation of the blood vessels triggers pain receptors, which release pain-causing prostaglandins, thereby increasing sensitivity to further pain. 

These signals are transmitted by the Trigeminal Nerve  – the Fifth (V) of our twelve cranial nerves.  Because the trigeminal nerve also senses facial pain, the brain interprets the pain signal as coming from the forehead – or what is called 'referred pain' since the cause of the pain is in a different location from where you feel it.

Theory 2 – Blood Flow Factor

Where food enters – and exits – our bodies are two of the most highly vascularized areas we have.  It’s why those are the two most common sites to take a temperature. 

Eating or drinking something very cold, especially when done rapidly, doesn’t allow the mouth enough time to absorb and acclimate to the cold very well.  This rapid change in temperature of the palate is where the internal carotid artery branches into the anterior cerebral artery.

Our brains are not fond of rapid change in their environment, and so as a self-defense mechanism, there is a rapid dilatation of the anterior cerebral artery to rush warm blood to the brain.  Given our brains are encased in a rather non-flexible skull, this extra blood flow causes an increase in Intracranial Pressure (ICP), which causes pain.

Surprising enough, the brain itself is not capable of feeling pain despite its billions of neurons.  But the meninges that cover the brain certainly can.  And it’s the stretching of the meninges from the increased ICP that causes the headache.

As the area warms up, the artery constricts, blood flow diminishes returning to normal, and the ICP drops back down again.  Headache gone!

This was rather eloquently demonstrated by Dr. Jorge Serrador, a cardiovascular electronics researcher at Harvard Medical School, who studied 13 volunteers.  They had their cerebral blood flow monitored in several brain arteries by a transcranial Doppler (a type of ultrasound).  They first sipped ice cold water through a straw aimed at their palate and were instructed to raise their hand when pain began. 

This was shown to correlate when the anterior cerebral artery dilated.

Then they raised their hand again when the pain went away.  And that correlated with the constriction of the anterior cerebral artery.

As a control they did the same thing while drinking room temperature water – and no changes were observed.

Dr. Jorge Serrador and his team presented these finding at the Experimental Biology 2012 meeting, San Diego, and they’ve been widely accepted as the current “Gold Standard”.

Here's a video that sort of combines the two theories together:

TREATMENT

So what should you do if you are one of the one-in-three who gets Brain Freeze? 

First and foremost (as always in medicine)  is prevention.  The surest way of that is avoidance – but who wants to give up the joy of ice cream, or Slurpees, or a dozen other frigid delights?

But it does help if you eat your cold item slowly – and try to avoid the palate.  So aim that straw away from the back of your mouth, and hold the food item in the front of your mouth to warm it up.

Intuitively drinking something warm, or even room temperature, will help alleviate that headache.  But since that’s not always available, sticking your tongue on the roof of your mouth is a good and socially acceptable remedy.

It’s also recommended to stick your nice warm thumb on your palate – something that may NOT be as socially acceptable.

You can also cup your hands over your mouth and catch the body-temperature expired air in an effort to warm up your palate.

NUGGETS

The similarity of the mechanics of Ice Cream Headache and migraines are strikingly similar.  It’s hoped that further study will may lead to better management of migraines.

The term "brainfreeze" was registered as a trademark by 7-Eleven in 1994

Worldwide, the town that drinks the most Slurpees (7-Eleven's brand of slushies) is chilly Winnipeg, Manitoba in Canada.

Maya Kaczorowski, a 13 year-old had her study, "Ice cream Evoked Headaches Study: Randomized Trial of Accelerated Versus Cautious Ice Cream Eating Regimen" published in the British Medical Journal and Scientific American

AND it appears that our feline friends can also get Ice Cream Headaches …

 

RESOURCES

https://en.wikipedia.org/wiki/Ice_cream_headache

http://www.medicalnewstoday.com/articles/244458.php

https://www.sciencedaily.com/releases/2013/05/130522095335.htm

http://chemistry.about.com/od/howthingsworkfaqs/f/how-brain-freeze-works.htm

http://www.kidzworld.com/article/4392-the-chilling-truth-about-brain-freeze

http://www.wikihow.com/Stop-Brain-Freeze

http://mentalfloss.com/article/12293/why-do-people-get-ice-cream-headaches

https://www.sciencedaily.com/releases/2012/04/120422231742.htm