Neurovascular disturbances in headache patients.

The prevalence of icecream headache, icepick-like pains and premonitory symptoms (changes in mood, appetite and alertness one to 24 hours before headache onset) was studied in 530 patients referred for neurological assessment of headache. Pain in the head after icecream or cold drinks was reported by 37% of patients, more often by those whose headaches were associated with focal neurological symptoms and gastrointestinal disturbances. The affected region coincided with that of the customary headache in 33% of patients questioned. Icepick-like pains were reported by 39% of patients and were restricted to the distribution of the customary headache in 40% of these. Premonitory symptoms were noted by 30% of patients, particularly those with focal neurological symptoms before or during the attack. Premonitory symptoms may form part of a diffuse cerebral or hypothalamic disturbance preceding headache, while the prevalence of icecream headache and icepick-like pains suggests that pain pathways and neurovascular reflexes to sensory stimulation are hyperexcitable even between headache episodes. These phenomena favour a neurological origin of migrainous headache.