If you’ve ever applied an ice pack to an injured knee or heating pad to a sore back, you know that hot and cold therapy can ease pain. And if you have migraines—especially migraine headaches that don’t completely respond to prescription or over-the-counter pain medication—you may want to know if temperature therapy can relieve migraine-related discomfort.

Researchers and migraine sufferers have explored the use of heat and cold therapy for migraine relief. Here’s what they’ve found.

Both heat therapy and cold therapy can be effective treatments for migraine. The National Headache Foundation and Mayo Clinic suggest both options, with the National Headache Foundation stating that “in general, most sufferers with migraine headache prefer cold packs.”

Cold therapy for migraine seems to have a longer history and broader scientific support than heat therapy. The first documented use of cold therapy (via a mixture of salt and ice) for headache was in 1849. A 2013 research article in the Hawai'i Journal of Medicine and Public Health noted that “cold therapy has long been the number one self-care treatment employed for migraine without aura and the second most common for migraine with aura.”

A number of studies have examined the effectiveness of cold therapy in decreasing migraine pain. A 2006 study in the journal Evidence-Based Complementary and Alternative Medicine asked migraine patients to don cold gel caps during two migraine attacks. Approximately 50 to 60% of patients reported increased comfort 25 minutes after putting on the cap. Eight to 11% of patients reported complete relief; 42 to 50% needed pain medication to help their headaches because cold therapy alone was not enough to sufficiently diminish their pain.

Interestingly, 77% of patients who had a good response to cold therapy during their first trial of the gel cap also experienced relief the second time they used the cold gel cap to treat migraine. About 60% of the patients who did not experience relief the first time around did not find cold therapy helpful the second time either. These results suggest that cold therapy may be a helpful treatment for some people with migraines but not for others.

A few other studies have investigated alternate cold therapy applications. One study reported in the Hawai'i Journal of Medicine and Public Health involved an adjustable neck wrap to hold ice packs over participants’ carotid arteries, the major blood vessels in the neck. Half of the study participants used the cold wrap for 30 minutes at the start of a migraine; the other half wore a similar wrap but without the ice packs.

Of those who used the ice wrap, 77% reported relief, compared to just 6.4% of those in the control group. People who used the ice wrap reported a significant decrease in pain, while those who used the wrap without ice noted an increase in pain. Almost 84% of patients in the control group eventually took pain medication to ease their pain; 58% of those who used the ice wrap also took pain medication.

Another study published in The Journal of Headache and Pain examined the use of intranasal cooling—essentially, delivering a coolant and oxygen to the inside of the nose via tubing—and found “considerable benefit” to patients with migraine. Most people (87%) who underwent the cooling treatment experienced symptom relief within two hours, with effects continuing for at least 24 hours.

Researchers know that cold causes blood vessels to contract (which may decrease inflammation) and decreases metabolic activity. Cold may also slow nerve conduction, so cold therapy may inhibit the transmission of pain signals.

Heat causes blood vessels to dilate and can be a trigger for some people with migraine. To date, there haven’t been any clinical research studies showing benefit of heat therapy in treatment of migraine, but some people who get migraines find heat therapy useful.

You can experiment with heat and cold therapy to see which provides greater migraine relief. Try applying a cold, moist cloth or warm, moist towel to your temples, forehead, neck, or around the base of your head (the nape of your neck). Alternately, you can use ice packs or a heating pad. If heat works for you, you can also try a warm bath or shower.

You can use temperature therapy in conjunction with prescription and over-the-counter medication, if desired. Whether you use a migraine ice pack or a migraine heat pack is ultimately up to you. If you are testing several techniques, it might be helpful to make a chart or take notes so you can find a pattern of what works best for you.

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