Ice Pick Headache - The Basics
These headaches aren't a form of migraine, but it's not unusual for migraineurs to experience them. These startling, sometimes frightening headaches have been described in various ways:
- "In the beginning, when I began having migraines, I suffered a sudden slash of pain, very intense and quick on the right side of my head. It started at one point and webbed out to what it felt like a inch in length. I had never felt this type of pain and it scared me."
- "They are intense, sharp, stabbing pain about your skull, as if you were being stabbed with an ice pick."
- "I was just wondering if anyone gets sudden pains in their heads. It can be in the front sometimes, or sometimes it's in my temple. It really varies."
- "I was awakened at 3 a.m. by excruciating, stabbing pains on the top right front of my head, kind of behind the eye. lasted about 30 seconds."
- "I get those types of stabbing pains too, I have no clue as to what is causing it. I get them all over my head. They can last for a few seconds to a few minutes. I started noticing them after my migraines started to get to where they were coming about 3-4 days a week."
- "In addition, I have these very sudden sharp pains in my head on a daily basis. It feels as if I'm being stabbed in the head."
What are they? They're primary stabbing headache, more commonly called "ice pick headaches." They are short, stabbing, extremely intense headaches that can be absolutely terrifying. They generally only last between five and 30 seconds. However, they come out of nowhere, can strike anywhere on the head, literally feel as if an ice pick is being stuck into your head, then disappear before you can even figure out what's happening. The pain can also seem to occur in or behind the ear.
Under the International Headache Society's International Classification of Headache Disorders, 3rd edition (ICHD-3)5, the official name for them is "primary stabbing headache. Other terms that have been used are ice-pick pains; jabs and jolts; needle-in-the-eye syndrome; ophthalmodynia periodica; sharp short-lived head pain. Ice pick headache is probably the most commonly used term because it's the most descriptive.
Here is the ICHD-3 information about primary stabbing headache:
"Transient and localised stabs of pain in the head that occur spontaneously in the absence of organic disease of underlying structures or of the cranial nerves."
Head pain occurring spontaneously as a single stab or a series of stabs and fulfilling criteria B–D
Each stab lasts for up to a few seconds
Stabs recur with irregular frequency, from one to many per day.
No cranial autonomic symptoms
Not better accounted for by another ICHD-3 diagnosis.
Comments: Studies show 80% of stabs last 3 seconds or less; rarely, stabs last for 10–120 seconds. Attack frequency is generally low, with one or a few per day. In rare cases, stabs occur repetitively over days, and there has been one description of status lasting 1 week.
4.7 Primary stabbing headache involves extratrigeminal regions in 70% of cases. It may move from one area to another, in either the same or the opposite hemicranium: in only one-third of patients it has a fixed location. When stabs are strictly localized to one area, structural changes at this site and in the distribution of the affected cranial nerve must be excluded.
A few patients have accompanying symptoms, but not including cranial autonomic symptoms. The latter help to differentiate 4.7 Primary stabbing headache from 3.3 Short-lasting unilateral neuralgiform headache attacks.
4.7 Primary stabbing headache is more commonly experienced by people with 1. Migraine, in which cases stabs tend to be localized to the site habitually affected by migraine headaches.
Ice pick headaches are considered a primary headache because they aren't caused by another condition or any underlying organic defect. Although they may occur independently, they're more likely to occur in patients who have another primary head pain disorder.1 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 headache disorder, primary stabbing 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 migraineurs, 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
In an article published in Current Pain and Headache Reports, Dr. Todd Rozen summarized the situation of people with ice pick headaches quite succinctly:
"The short-lasting headache syndromes are unique based on their short duration of pain and their associated symptoms. Physicians need to be knowledgeable about these syndromes because each has its own distinct treatment and if the diagnosis is missed, the patient can be burdened with extreme headache-related disability."2
If you're experiencing what you think may be ice pick headaches, please don't just assume that's what they are. Log them in your diary, and go see your doctor. As with any other head pain, there can be too many possible causes to guess. A doctor's diagnosis is vital.
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More Helpful Information from Our Basics Series:
Migraine with Brainstem Aura – The Basics (formerly called basilar-type migraine)
1 Newman, Lawrence C., MD. "Effective Management of Ice Pick Pains, SUNCT, and Episodic and Chronic Paroxysmal Hemicrania." Current Pain and Headache Reports 2001, 5:292–299.
2 Rozen, Todd D., MD. Short-lasting Headache Syndromes and Treatment Options. Current Pain and Headache Reports 2004, 8:268–273
3 Young, William B., MD, and Silberstein, Stephen, D., MD. "Migraines and Other Headaches." American Academy of Neurology Press Quality of Life Guide. 2004. pp 140-141.
4 Tepper, Stewart J., MD. "Understanding Migraine and Other Headaches." University Press of Mississippi. 2004. pp 97-98.
5 International Headache Society. "International Classification of Headache Disorders, 3rd edition." Cephalalgia. July 2013 33: 629-808, doi:10.1177/0333102413485658