74 Headache Medicine, v.2, n.2, p.74, Apr./May/Jun. 2011

Headache attributed to cold stimulus (HACS) occurs

during the application of this stimulus externally to an individual

or when it is swallowed or inhaled. The pain is described like

a short duration one and can be acute. Most studies show a

greater susceptibility in migraine suffering individuals as for

developing it, but these gears are not well clarified yet.

Objective: Estimating the prevalence and analyzing the

clinical characteristics of HACS and its relation to migraine.

To evaluate if IHS criteria are enough to the diagnosis of HACS

in a population, by using an experimental model of cold

stimulus induced headache test.

Method: 414 volunteers were interviewed in a random

way, through a self-administered questionnaire identifying

age, sex and headache history. Migraine diagnosis was made

based on diagnosis criteria of the IHS. To induce the cold

stimulus headache, it was used a standardized ice cube (20

x 15 x 35 mm) at the palate area for 90s. The HIT questionnaire

test about pain impact was applied to this sample.

Results: Of the 414 volunteers 266 (64.3%) were

females and 148 (35.7%) were males. There was an age

variety from 8 to 84-year-old (30.6 ± 12.4). Of the tested

individuals 153/414 (37%) had cold stimulus induced

headache [106/266 females (39.8%) and 47/148 males

(31.8%), p = 0.126, χ²]. The frontal and temporal areas

were the most affected ones, with bilateral predominance and

of the throbbing type. Among the individuals who presented

previous headache 147/379 (38.8%) referred pain in the

cold stimulus headache test. Among those who had not

presented previous headache, only 7/35 (20%) referred pain

in the test (p = 0.028, χ²). Of the previous headache carriers

240/379 (63.3%) were migraine sufferers and 139/379

(36.7%) were not migraine sufferers. The cold stimulus

induced headache test was positive in 47.9% of the migraine

sufferers (115/240) and in 23% of the non-migraine sufferers

(32/139) (p < 0.0001, χ²). Migraine sufferers presented a

higher percent of sensibility to ice (47.9%) when compared to

those who are not migraine sufferers (23%) and to those who

had not any history of previous headache (20%) (p<0.0001,

χ²). Of the migraine sufferers 133/240 (55.4%) referred

previous history of HACS in relation to the non-migraine

sufferers 58/139 (41.7%) (p = 0.014, χ²). Individuals who

had previous history of HACS are five times as likely to evolve

it (RR 5.52, IC 3.76 - 8.09). There was not statistics difference

in relation to age in the tested groups (positive test 28.6 ±

11.8 versus negative test 31.7± 15.7, p=0.2008 Mann-

Whitney). Individuals with history of previous headache are

twice more likely to evolve HACS (RR 1.939 (0.988 - 3.807).

Of the 147 interviewed individuals with a previous history of

headache who had a positive test, 71 (48.3%) of them referred

HACS at the same habitual place of the previous headache.

Volunteers with a positive cold stimulus induced headache

test had greater scores in HIT (p=0.0001).

Conclusion: HACS is predominantly frontotemporal,

bilateral and throbbing, affecting more commonly migraine

sufferers. IHS criteria are imperfect to HACS diagnosis.

Correspondence

Dra. Daniella Araújo de OliveiraDra. Daniella Araújo de Oliveira

Dra. Daniella Araújo de Oliveira

sabino_daniella@ig.com.br

Headache attributed to ingestion or inhalation of a cold

stimulus (Abstract)

Cefaleia atribuída à ingestão ou inalação de estímulo frio (Resumo)

Daniella Araújo de Oliveira

Universidade Federal de Pernambuco. Pós-graduação de Neuropsiquiatria e Ciências do Comportamento

(área de concentração: Neurociências). Ph.D. Thesis. Recife, 2009. Orientador: Marcelo Moraes Valença

Oliveira DA. Headache attributed to ingestion or inhalation of a cold stimulus (Abstract).

Headache Medicine. 2011;2(2):74

THESES