Ice Pick Headaches

“Ouch!” you scream as a searing bolt of pain hits your head. Before you can explain what just happened, the pain is gone. It only lasted seconds, but felt like you’d just been stabbed in the head with an ice pick.

How are ice pick headaches different than migraine?

They’re called primary stabbing headaches or, more commonly, “ice pick headaches.” While not migraine attacks, they do occur in patients with a history of migraine.1 In most cases, they are infrequent and require no special treatment. However, patients who experience frequent attacks may be prescribed indomethacin as a preventive.2 Indomethacin is a prescription NSAID.

Where does the pain occur?

The pain of primary stabbing headaches are most often felt in the frontal and temporal regions and can vary from one location to another.2,3 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 your symptoms.1

How are they diagnosed?

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:

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.

How are primary stabbing headaches different?

What sets this headache disorder apart from others that involve stabbing pain is the irregular occurrence and lack of cranial autonomic symptoms, such as redness or tearing of the eyes.1 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.

What other names does it go by?

Other names for ice pick headaches include:

  • Ice-pick pains
  • Jabs and jolts syndrome
  • Needle-in-the-eye syndrome
  • Ophthalmodynia periodical
  • Sharp, short-lived head pain

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