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.

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. 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 (like Prilosec) to be taken along with indomethacin as a precaution.

Diagnosing primary stabbing headache

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 your 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 pains; jabs and jolts; needle-in-the-eye syndrome; ophthalmodynia periodica; sharp short-lived head pain.

Description

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.

Diagnostic criteria

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.