Primary Stabbing Headache, aka Ice Pick Headache is one of the most frequently searched forms of Headache in Internet search engines. They strike suddenly, a searing bolt of pain, and before you can explain what happened, the pain is gone just as suddenly.
They last mere seconds, but feel as if you’ve just been stabbed in the head with an ice pick. Thus, the alternative name.
These startling, sometimes frightening Headaches have been described in various ways:
“In the beginning, when I began having migraines, I suffered a sudden slash of pain, very intense and quick on the right side of my head. It started at one point and webbed out to what it felt like a inch in length. I had never felt this type of pain and it scared me.”
“They are intense, sharp, stabbing pain about your skull, as if you were being stabbed with an ice pick.”
“I was just wondering if anyone gets sudden pains in their heads. It can be in the front sometimes, or sometimes it’s in my temple. It really varies.”
“I was awakened at 3 a.m. by excruciating, stabbing pains on the top right front of my head, kind of behind the eye. lasted about 30 seconds.”
“I get those types of stabbing pains too, I have no clue as to what is causing it. I get them all over my head. They can last for a few seconds to a few minutes. I started noticing them after my migraines started to get to where they were coming about 3-4 days a week.”
“In addition, I have these very sudden sharp pains in my head on a daily basis. It feels as if I’m being stabbed in the head.”
While these Headaches aren’t Migraine attacks, they do occur more frequently in patients with a history of Migraine. They’re short, stabbing, extremely intense Headaches that can be absolutely terrifying. They generally only last between five and 30 seconds. However, they come out of nowhere, can strike anywhere on the head, feel as if an ice pick is being stuck into your head, then disappear before you can even figure out what’s happening. The pain can also seem to occur in or behind the ear.
In most cases, they are infrequent and require no special treatment. However, patients who experience frequent attacks may be prescribed indomethacin as a preventive. Indomethacin is a prescription NSAID with a high rate of gastrointestinal side effects. Many times doctors will prescribe a proton-pump inhibitor (such as Prilosec) to be taken along with indomethacin as a precaution.
Diagnosing primary stabbing headache
For people with Migraine, Primary Stabbing Headaches most often affect the same side as Migraine attacks. Most of the time the stabbing is felt in the occipital and temporal regions rather than in the face or eye, so it generally does not involve the trigeminal nerve. The pain can vary from one location to another. If attacks occur in exactly the same spot over and over, your doctor may want to rule out structural or functional changes that better explain the symptoms.
What sets this Headache disorder apart from others that involve stabbing pain is the irregular occurrence and lack of redness or tearing of the eyes. If the attacks occur in a predictable pattern or include eye redness and tearing, then a visit to your Headache specialist is warranted to rule out more serious headache disorders such as Cluster Headache, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), short lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA), or trigeminal neuralgia.
Headache specialists use the ICHD-3 to assess and diagnose Headache disorders. The description and diagnostic criteria for Primary Stabbing Headache included in the ICHD-3 is listed below.
Previously used terms
Ice pick headaches, Ice-pick pains; jabs and jolts; needle-in-the-eye syndrome; ophthalmodynia periodica; sharp short-lived head pain.
Transient and localized stabs of pain in the head that occur spontaneously in the absence of organic disease of underlying structures or of the cranial nerves.
A. Head pain occurring spontaneously as a single stab or series of stabs and fulfilling criteria B–D
B. Each stab lasts for up to a few seconds (80% last 3 seconds or less)
C. Stabs recur with irregular frequency, from one to many per day
D. No cranial autonomic symptoms (redness of the eye and tearing)
E. Not better accounted for by another ICHD-3 diagnosis.
Studies show 80% of stabs last 3 seconds or less; rarely, stabs last for 10–120 seconds. Attack frequency is generally low, with one or a few per day. In rare cases, stabs occur repetitively over days, and there has been one description of status lasting 1 week.
4.7 Primary stabbing headache involves extratrigeminal regions in 70% of cases. It may move from one area to another, in either the same or the opposite hemicranium: in only one-third of patients it has a fixed location. When stabs are strictly localized to one area, structural changes at this site and in the distribution of the affected cranial nerve must be excluded.
A few patients have accompanying symptoms, but not including cranial autonomic symptoms. The latter help to differentiate 4.7 Primary stabbing headache from 3.3 Short-lasting unilateral neuralgiform headache attacks.
4.7 Primary stabbing headache is more commonly experienced by people with 1. Migraine, in which cases stabs tend to be localized to the site habitually affected by migraine headaches.
- Headache Classification Committee of the International Headache Society. “The International Classification of Headache Disorders, 3rd Edition (ICHD-3). Cephalalgia, Volume: 38 issue: 1, page(s): 1-211.