Ice Pack or Heat Pad? What Actually Helps During a Migraine Attack

When a migraine attack hits, you’re most likely reaching for whatever brings relief fastest. And it turns out a lot of us already know what works: in the Migraine Buddy community, 35% of users say ice packs bring relief, and 25% reach for a heat pad instead. Hot showers do even better, with around 40% of users finding them helpful.

Not everyone gets relief this way, though. About 40% of users tell us that nothing they try really touches the pain, and that’s an important reminder too: migraine looks different from person to person, and what works for someone else might not work for you.

So what’s actually happening in your body when you press something cold, or something warm, against your head or neck? And why does it help some people and not others? Let’s walk through it simply.

What Cold and Heat Do to Your Body

Cold and warmth do almost opposite things, which is why both can help, just for different reasons.

Cold makes your blood vessels narrower

This is called vasoconstriction, which means the blood vessels in that area tighten up a little. That can calm down some of the throbbing and swelling that come with an attack [1].

Cold also has a numbing effect: it sends a strong, cool signal to your brain that can crowd out the pain signal, so you feel the cold more than you feel the ache underneath it [1].

Heat makes your blood vessels wider

This is called vasodilation, and it increases blood flow and helps loosen up tight muscles in your neck and shoulders [2]. That’s often why a hot shower or a heat pad feels so good when your migraine attack comes with a stiff neck or tense shoulders.

Heat has a downside too: warmth can stimulate the trigeminal nerve, the same nerve pathway behind migraine pain [2]. So heat can help one day and backfire the next, depending on what’s driving the pain. If that happens to you, it’s not you doing anything wrong, it’s just your body telling you what it needs right now.

What Does the Research Say

Science of Cold

A 2023 review that pulled together six different studies found that cold packs and cold wraps gave people a real, short-term drop in migraine pain [3]. One study measured it directly: pain dropped by about 32% within 30 minutes of applying a cold wrap to the neck, while people who got no treatment at all saw their pain go up slightly over that same half hour [4].

A separate pilot study tested a topical menthol gel, which activates the same cold-sensing receptors in the skin as an ice pack, applied to the back of the head during a migraine attack, and found that just over half of participants had no pain or only mild pain within two hours [5].

Science of Heat

Heat has fewer studies built specifically around migraine, but the ones that exist are encouraging. A 2021 randomized trial that compared heat, cold, and no treatment in patients with migraine-type headache found that both heat and cold led to a meaningfully bigger drop in pain than no treatment at all [6].

Another trial added warm arm and foot baths, paired with cold applied to the head, on top of standard migraine medication, and found it reduced both the frequency and intensity of attacks over six weeks, more than medication alone [7].

A Few Things Worth Knowing Before You Try It

Ice packs and heat pads are about as low-risk as migraine relief gets, but a couple of things are worth keeping in mind.

For cold:

• Fifteen minutes at a time is a good rule of thumb, longer than that and you’re not getting extra benefit, just extra cold [8].
• If you have Raynaud’s phenomenon (a condition where cold makes your fingers or toes turn pale or numb), a cold allergy, or another condition that makes your body react strongly to cold, check with your doctor before using ice packs regularly [9].
• If you have reduced feeling in your skin for any reason, be extra careful, it’s easy to leave a cold pack on too long without noticing [9].

For heat:

• Never fall asleep with a heating pad on. It’s one of the easiest ways to accidentally burn your skin [8].
• If your migraine attack already comes with a hot, flushed feeling in your head, heat might make that worse rather than better, since it widens blood vessels even further [2].
• If you have a heart condition or circulation issues, talk to your doctor before making heat therapy a regular habit [10].

For most people living with migraine, a simple ice pack or a warm compress can be a gentle, low-effort way to find some comfort, whether you’re trying to head off an attack or just get through one. Everyone’s experience is a little different, though, so it’s worth paying attention to what your body responds to and tracking it over time.

If you’re ever unsure, or if temperature therapy isn’t giving you the relief you’re hoping for, your doctor is always a good next step.

References

1. Uçler S, Coşkun O, İnan LE, et al. Cold Therapy in Migraine Patients: Open-label, Non-controlled, Pilot Study. Evidence-Based Complementary and Alternative Medicine. 2006;3(4):489-493. https://pmc.ncbi.nlm.nih.gov/articles/PMC1697736/
2. Migraine Buddy. Coping with Migraine and Heat Sensitivity. https://migrainebuddy.com/coping-with-migraine-and-heat-sensitivity/
3. Hsu YY, Chen CJ, Wu SH, Chen KH. Cold intervention for relieving migraine symptoms: A systematic review and meta-analysis. Journal of Clinical Nursing. 2023;32(11-12):2455-2465. https://pubmed.ncbi.nlm.nih.gov/35596276/
4. Sprouse-Blum AS, Gabriel AK, Brown JP, Yee MH. Randomized controlled trial: Targeted neck cooling in the treatment of the migraine patient. Hawaii Journal of Medicine & Public Health. 2013;72(7):237-241. https://pmc.ncbi.nlm.nih.gov/articles/PMC3727573/
5. St. Cyr A, Chen A, Bradley KC, Yuan H, Silberstein SD, Young WB. Efficacy and tolerability of STOPAIN for a migraine attack. Frontiers in Neurology. 2015;6:11. https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2015.00011/full
6. Bagherzadi A, Emani R, Ghavami H, Khalkhali HR, Ebrahimi M. Comparing the effect of heat and cold therapy on the intensity of nitrate induced migraine type headache in cardiac inpatients: A randomized controlled trial. Agri. 2021;33(3):148-154. https://pubmed.ncbi.nlm.nih.gov/34318912/
7. Sujan MU, Rao MR, Kisan R, Abhishekh HA, Nalini A, Raju TR, Sathyaprabha TN. Influence of hydrotherapy on clinical and cardiac autonomic function in migraine patients. Journal of Neurosciences in Rural Practice. 2016;7(1):109-113. https://pmc.ncbi.nlm.nih.gov/articles/PMC4750306/
8. American Migraine Foundation. Migraine Home Remedies. https://americanmigrainefoundation.org/resource-library/migraine-home-remedies/
9. Physiopedia. Cryotherapy Guidelines. https://www.physio-pedia.com/Cryotherapy_Guidelines
10. Spine-health. Potential Risks and Contraindications of Heat Therapy. https://www.spine-health.com/treatment/heat-therapy-cold-therapy/potential-risks-and-contraindications-heat-therapy