Cooling Cap / Menthol Gel

Summary:
Cooling interventions such as menthol-based gels or ice caps are used during acute migraine attacks to reduce local inflammation and nerve sensitivity.

Biological Plausibility

Cold reduces nociceptor sensitivity and inflammation. Pericranial nerve endings are likely modulated, particularly in early-phase attacks.

Evidence

Small crossover trials show benefit for acute pain relief. Not shown to reduce attack frequency.

Effect Size

Modest acute pain relief when applied early. Not preventive.

⚠️ Risk

Minimal. Skin irritation or discomfort may occur if applied too long.

Cost

$

Scores

• Benefit: 1
• Burden: 1
• Ratio: 1.0

Clinical Takeaways

• Safe, inexpensive acute therapy.
• Best applied at onset of symptoms.
• May complement pharmacologic or neuromodulation treatments.

Key References

• Singh P, et al. *Targeted neck cooling in the treatment of migraine.* Headache. 2013.
• Kernick D, et al. *Cold therapy for acute migraine: a randomized trial.* Cephalalgia. 2008.