A tribute to Neil Raskin and ice-cream headache
Dr Neil Raskin is a pioneer of headache medicine who is still practicing at 83 years old in San Francisco. He described the famous «DHE Raskin Protocol» that helped so many patients. But do you know those four special headaches that were described by Dr Raskin?
This particular headache occurs only during sleep. It makes the sufferer get out of bed and pace around. Usually it lasts 1-2 hours and will eventually calm down. Interestingly, it can be treated by caffeine before bedtime. Other options (to be discussed with a health care professional) include indomethacin and lithium.
Have you ever experienced this intense pain that comes after gulping too much ice cream or slush? According to a study in Taiwan, 40% of adolescents report this. Sensitivity to ice-cream headache has been associated with migraine, and it seems to run in families. It is thought that the cold stimulation of the palate and throat triggers an excessive response from the pain matrix in the brain.
Primary Stabbing Headache or «ice-pick headache»
Do you know what it feels like to feel a sharp pick somewhere in your skull for a very brief moment? And then somewhere else, unpredictably? Quite scary, right? This particular type of pain is also associated with migraine and is typically benign. Frequency may vary greatly, and increase during stressful periods.
This is not really a type of headache, but more of a trigger. The nitrites present in industrial sausages may trigger migraine in certain individuals. Dr Raskin was very interested in chemical triggers of migraine and also brought attention on tyramine, alcohol and monosodium glutamate. We know now that food triggers are not universal, but they can still be very relevant to a subgroup of patients.
What is DHE?
DHE, or dihydroergotamine, is a medication acting on serotonin receptors. It is a chemical cousin of triptans. It has the interesting particularity of not causing medication overuse. It has been used in injectable forms (IV and SC) to treat intractable migraine (for example in the emergency department) and help during overuse withdrawal. DHE is still used today, though availability varies with frequent back-orders.
Check our DHE injection guide on www.migrainecanada.org !
Thank you Dr Raskin for these important research contributions!
IMPORTANT: any new headache can be the warning sign of a serious disease. If you are concerned about a headache, please do seek medical assessment.
Written by Dr Elizabeth Leroux