What is this Stabbing Headache?
Updated October 18, 2014.
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
Do you experience stabbing head pains? The name associated with this headache disorder is primary stabbing headache. It has previously been referred to as an ice-pick headache or the jabs and jolts syndrome.
Let's review the basics of a primary stabbing headache and how to treat it.
Symptoms
According to the classification criteria of the second edition of the International Classification of Headache Disorder (ICHD-II), symptoms of primary stabbing headache include:
- A single stab or series of stabbing pains
- Occurring in the region of the trigeminal nerve, which is around or behind the eye, on the temple, or in the cheek area
- Short acting, typically lasting 1 to 10 seconds
- Stabs appear in an irregular manner, occurring once to multiple times a day
- Symptoms are not explained by another medical condition
- No associated symptoms (i.e. no photophobia or phonophobia, as you may see in migraine)
Diagnosis
In order to make the diagnosis, your neurologist or headache specialist may have you undergo imaging of your brain, such as a magnetic resonance imaging (MRI) of the brain. This will ensure that there is no other cause for your stabbing head pain, especially since primary stabbing headache is not very common. Causes of a headache that may mimic primary stabbing headache, but are really secondary headaches include:
- Trigeminal Neuralgia
- Injury to the Scalp
- Nummular Headache
- Brain Tumor
Cause
The "why" behind this headache disorder is largely unknown. Interestingly, this rare type of headache is more commonly felt by those who also suffer from migraines or cluster headaches.
It is also associated with another headache disorder, hemicrania continua.
Treatment
In primary stabbing headache, the "stabs of pain" are so quick that you really cannot treat the acute pain. Rather, a medication that prevents the stabs in the first place is ideal. While there are no randomized controlled trials examining specific medical therapies for primary stabbing headache, there are a couple medications used to prevent this disorder.
Indomethacin, a non-steroidal anti-inflammatory drug or NSAID, is one such drug. Indomethacin, an NSAID that reduces cerebrospinal fluid (CSF) pressure and brain blood flow, is also used to treat other rare headache disorders, like primary cough headache. Indomethacin does have limiting side effects. Examples of these include:
- gastrointestinal upset and/or bleeding
- high potassium
- dizziness
- blurry vision
- increased risk of cardiovascular events (i.e. heart attacks, stroke)
Due to these adverse effects, indomethacin may not be a drug that individuals can take for an extended period of time.
Melatonin, which has a similar chemical structure to indomethacin, is a hormone produced by the pineal gland, a gland in our brain that helps regulate sleep cycles and our circadian rhythm. In one study in Neurology, three patients with primary stabbing headache were each given melatonin at night at the following respective doses: 3mg, 9mg, and 12mg. These patients remained pain-free of their stabbing headache at followup, which was at 2 months, 4 months, and 2 months, respectively.
Take Home Points
- A primary stabbing headache, previously known as an ice-pick headache, is an uncommon primary headache disorder characterized by stabs in the facial area that last seconds at a time.
- Your doctor may recommend brain imaging in order to confirm your diagnosis of primary stabbing headache.
- Treatment for primary stabbing headache may include indomethacin or melatonin, although there are no randomized controlled studies yet.
Of course, if you have any questions or concerns regarding your headache diagnosis or if you have a new onset headache or one that follows a different pattern, contacting your healthcare provider is important.
Sources
Fuh JL, Kuo KH, Wang SJ. Primary stabbing headache in a headache clinic. Cephalalgia.2007 Sep;27(9):1005-9.
Headache Classification Subcommittee of the International Headache Society. "The International Classification of Headache Disorders: 2nd Edition". Cephalalgia 2004;24 Suppl 1:9-160.
http://online.lexi.com/lco/action/doc/retrieve/docid/patch_f/7003#rfs. Accessed 3/24/14.
Pareja JA1, Ruiz J, de Isla C, al-Sabbah H, Espejo J. Idiopathic stabbing headache (jabs and jolts syndrome). Cephalalgia. 1996 Apr;16(2):93-6.
Rozen TD. Melatonin as treatment for idiopathic stabbing headache. Neurology. 2003 Sep 23;61(6):865-6.
DISCLAIMER: The information in this site is for educational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for diagnosis and treatment of any concerning symptoms or medical condition.
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