( 11) reported the efficacy of a non-invasive technique, intra-oral chilling, for acute migraine headache pain when compared with oral sumatriptan or placebo. They reported that application of cold was the most-used manoeuvre in migraine without aura ( 8). Self-administered pain relief manoeuvres have been investigated in primary headache patients. Today, some patients report that they treat their headache using physical therapies, including cold application ( 5, 8– 10). They showed that simultaneous pressure of heat and cold reduced the headache's duration ( 7). In another study, the efficacy of extra-cranial pressure in combination with cold to treat headaches was supported. James Arnott wrote a manuscript on cold therapy in which he used a mixture of salt and ice in patients to treat headache ( 6). The first cold treatment was done for headache patients in 1849. Ancient Greek and Egyptian writings show that physicians of that time were concerned about this disease and bloodletting and craniotomy was used in some patients with headache ( 2, 5). There are some reports which support the efficacy of acupuncture in the treatment of pediatric pain, including migraine ( 4). Various non-pharmacological methods including massage, trigger point therapy, reflexology, spinal manipulation, therapeutic heat or cold and exercise therapy have also been investigated in the past for migraine patients ( 1– 3). Migraine headache is generally treated by anti-migraine agents, analgesics and anti-emetic agents. Its combination with conventional drugs should be investigated in future studies. Cold application alone may be effective in some patients suffering from migraine attacks. Twenty-five minutes after treatment of the second attack, VAS score was decreased from 7.7 ± 1.8 to 5.4 ± 3.55 ( P < 0.01). Twenty-five minutes after treatment of the first attack, VAS score was decreased from 7.89 ± 1.93 to 5.54 ± 2.96 ( P < 0.01). Therefore, therapeutic efficacy was evaluated in 26 patients. Two patients could not use this therapy due to side effects (one due to cold intolerance and one due to vertigo) in both applications. They recorded their VAS score just after the therapy and 25 min, 1 h, 2 h and 3 h later. Patients used this cap for 25 min in each application. Before and after the cold therapy, headache severity was recorded by using visual analogue scale (VAS). Patients used this cap during their two migraine attacks. Cold therapy was administered to them by gel cap. Twenty-eight migraine patients were included. In this study, we investigated the effect of cold application on migraine patients. There are only a few reported studies related to cold therapies in patients with migraine. Some patients with headache report that they have frequently used physical therapies such as application of cold to relieve their headache.
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