Migraine is arbitrarily defined; biological markers for the condition are needed. Two stereotyped phenomena which may be manifestations of central vasomotor instability have been studied in migraineurs and in control subjects. These phenomena are (1) “ice cream headache”, the brief frontal pain that results from cold food contacting the roof of the oropharynx and (2) the presence of vertigo, visual obscurations, and/or scintillating scotomata following rapid postural shifts of the head.

Hospitalized (non-neurologic) patients (60 women, 48 men) were interviewed regarding the presence, quality, and intensity of the two phenomena. A history of headache was then elicited in some detail. The headache histories were assessed by the usual arbitrary criteria for migraine; this was done by an independent observer without knowledge of the presence of ice cream headache or postural symptoms. In the non-headache, control population (49), 31% had experienced mild ice cream headache; in the migraine group (59), 93% had experienced ice cream headache (p<.001), usually (77%) as a moderate to severe discomfort. Half of the migraineurs took precautions when ingesting cold foods. Of the controls, 8% had brief vertigo or lightheadedness with rapid postural shifts; postural symptoms were present in 68% of the migraine group (p>.001), most of whom (75%) reported that scintillating scotomata accompanied vertigo. Both syndromes occurred more regularly and more prominently in the migraine population.