Ice Pick Headaches - The Basics

The International Headache Society diagnostic criteria is:

1. Head pain occurring as a single stab or a series of stabs and fulfilling criteria B–D
2. Exclusively or predominantly felt in the distribution of the first division of the trigeminal nerve (orbit, temple and parietal area)
3. Stabs last for up to a few seconds and recur with irregular frequency ranging from one to many per day
4. No accompanying symptoms
5. Not attributed to another disorder

Ice pick headaches are considered a “primary headache” because there isn't a deeper underlying cause. The headache itself is the problem. Although they may occur independently, they're more likely to occur as part of another primary head pain disorder.¹ A secondary headache has another cause such as a tumor, stroke, or something as simple as not eating.

These short, sharp headaches can be located anywhere on the head, but they're usually located near the orbit, temple, or parietal region (the region near the parietal bone, one of two bones that form the posterior roof and sides of the skull).²

Although people who experience ice pick headaches are usually those who have Migraine disease, or another head pain disorder, the ice pick headaches usually occur by themselves rather than during a Migraine attack or headache. Usually, they occur a few times a day at most. In rare cases, however, they occur frequently through the day, requiring treatment. The major problem with treatment, of course, is that the pain is so brief, if it's not treated until it occurs, it's gone before the patient can even take medication. In those rare cases where it does need treatment, preventive treatment with indomethacin (Indocin) usually works.³

Ice pick headaches occur in up to 40% of individuals who experience Migraines, often located in or near the usual location of their Migraines. They can occur at any time of day or even wake people from sleep. Those who do need to use indomethacin for prevention should remember that it is an NSAID, and has the potential side effects typically associated with NSAIDs. Those potential side effects include heartburn, nausea, gastroesophageal reflux and bleeding problems, and gastric ulcers. In rare cases, indomethacin can cause eye problems. Thus annual examinations by an ophthalmologist are recommended for anyone taking it on a regular basis.⁴