Primary Stabbing Headache (Ice Pick Headache)

The Basics of Stabbing Headaches

Stabbing headaches, or “ice pick headaches,” are short, stabbing, extremely intense headaches that generally last only seconds. Stabbing headaches can be either:

  • “Primary,” meaning that the headache itself is the problem; or
  • “Secondary,” meaning that there is an underlying cause or condition responsible for the headache.

People with new or never-evaluated stabbing headache (ice pick headache) should be carefully assessed by their doctor for an underlying cause. Also, they should be evaluated to make sure that they do not have a different primary headache disorder that can mimic primary stabbing headache. Other primary headache disorders that mimic primary stabbing headache include: short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA), occipital or other cranial neuralgias, trigeminal neuralgia or nummular headache.

Primary stabbing headache has been previously called ice-pick pains; jabs and jolts; needle-in-the-eye syndrome; ophthalmodynia periodica; and sharp short-lived head pain.

Symptoms of Primary Stabbing Headache (Ice Pick Headaches)

People with primary stabbing headache describe single or multiple stabs of pain that occur out of the blue. The stabs last only seconds, with the majority lasting under 3 seconds, and occur only once to a few times per day. The stabs usually move from one area to another in either the same or the opposite side of the head. If the stabs occur only in one place, it is important to see your doctor to exclude structural changes or injury to a nerve at that site.

If you get watery or red eyes, runny or stuffy nose or swelling and flushing of your face with the stabbing pains, you may have a different headache disorder called short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) or short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) and should see your doctor.

Primary stabbing headache is more common in people with migraine and often can occur in the same location where they get their migraine headache.

Please refer to the International Classification of Headache Disorders 3rd edition website for more information on the criteria used to diagnosis primary stabbing headache.

Treatment of Primary Stabbing Headache

Usually, primary stabbing headache occurs a few times a day at most. In rare cases, however, they occur more frequently, requiring treatment. The major problem with treatment is that the pain is so brief that it is gone before the person can even take medication. In those rare cases where it is happening so frequently that it does need treatment, preventive treatment—a medicine that you take every day whether you have pain or not to prevent the pain from occurring—is recommended. Melatonin or indomethacin may be helpful for prevention of primary stabbing headache. Those who do need to use indomethacin for prevention should remember that it is a non-steroidal anti-inflammatory drug (NSAID) and has potential side effects typically associated with NSAIDs. Some potential side effects include heartburn, nausea, gastroesophageal reflux, bleeding problems and stomach ulcers.

Summary of Ice Pick Headaches

Primary stabbing headache is an uncommon headache disorder of short, stabbing, extremely intense headaches that last only seconds in duration and usually occur at most a few times per day. Treatment is often not required due to the brief and infrequent nature of these headaches, but evaluation by your doctor is always required. If you’re experiencing what you think may be primary stabbing headache (ice pick headaches), please don’t assume that’s what they are. As with any other head pain, there can be many causes, and a doctor’s diagnosis is needed.

Resources:

  • The International Headache Society. https://www.ichd-3.org/other-primary-headache-disorders/4-7-primary-stabbing-headache/
  • Hagler S, Ballaban-Gil K, Robbins MS. Primary stabbing headache in adults and pediatrics: a review. Curr Pain Headache Rep 2014; 18:450
  • Fuh JL, Kuo KH, Wang SJ. Primary stabbing headache in a headache clinic. Cephalalgia 2007; 27:1005.
  • Rozen TD. Melatnin as treatment for idiopathic stabbing headache. Neurology 2003; 61:865