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.

Poll


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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
  1. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalgia. 2013; 33(9) 677-678.

Comments

View Comments (9)
  • TBurns
    12 months ago

    I have experienced Icepick headaches along with migraines for years. I was prescribed Topamax to help prevent migraines from a primary care doctor years before I found a headache specialist. I had run out of my prescription and didn’t take the topamax for a few weeks. My icepick headaches went away. I restarted Tyner topamax and they came back. I have now been taken off topamax and no longer have icepick headaches. For me there was definitely a correlation between topamax and icepick headaches.

  • Charlotte Best
    3 years ago

    Now I know what to call these headaches. The pain from my ice pick headache is so intense it makes me shiver, but the pain is so fleeting it’s almost impossible to explain. For years I would have these headaches at intermittent times and for no particular reason, long before I ever experienced migraines. Now I will still have them but infrequently; I experience migraines more than ice pick headaches. Thanks for the information.

  • zetetic
    3 years ago

    Oddly enough, 6 mg of slow release melatonin (which has anti-inflammatory properties similar to indocin) resolved my ice pick headaches which then help resolved my migraines (one was apparently major trigger for the other).

  • James Weil
    3 years ago

    I had only one and one was enough. It happen in the shower and it was so painful it dropped me to my knees and my scream probably woke the neighborhood. For those of you familiar with them (my empathy and condolences) it was as painful as a kidney stone.

  • ddnben
    3 years ago

    What about the “2×4” headache? I have where I get hit over the head by a 2×4. I can be sound asleep and be woke up by that. As in the case of the ice pick headache, it doesn’t last long but it sure hurts. Always good information on this site. I’m in the middle of a long migraine stretch (2 weeks) and a bit frustrated at not being able to break it.

  • Tammy Rome author
    3 years ago

    I’m so sorry you are having a long stretch of migraine. It wears us down, making it difficult to stay proactive. I sure hope that you have a good doctor who is trying to help you break this bad round.

  • vostie
    3 years ago

    I also experience mild stabbing pains for the first week after Botox injections.

  • joey4420
    3 years ago

    I hate these, especially when driving. They are also hard to explain to friends or co-workers who have never really had headaches at all.

  • Nancy Harris Bonk moderator
    3 years ago

    Thanks Tammy, great information.

    Nancy

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