Ice Pick headaches

Ice pick headaches are sharp, stabbing pains occurring as a single stab or as a series of stabs, occurring mostly in the eye and orbit, temple, or parietal regions. Stabs last a few seconds, and may recur throughout the day, usually at irregular intervals. This headache type is not well understood, even though it occurs more commonly in migraine sufferers. Although this is often referred to as ice pick headache, the official term according to the International Headache Society is Primary Stabbing Headache. It has also been referred to as "jabs and jolts."

Treatment of icepick headaches is difficult, because the pain comes and goes too quickly to take anything. These stabbing head pains tend to be a little more common if you also have migraines or cluster headaches, but ice pick headaches can occur independently. Some studies indicate a female predominance for icepick headaches.

Although this headache type is sometimes listed as one of the less frequently occurring headaches, some version of the phrase “ice pick headache” remains in the top search terms for this website month after month. So, either it occurs more frequently than previously appreciated, or the symptoms are so terribly bothersome that it drives sufferers to seek information. Perhaps both. Some estimates have indicated that as many as 40% of migraine sufferers may also have had ice pick headaches at some time in their lives, but there is no good epidemiologic data available to confirm this.

What are Ice Pick Headaches?

Ice pick headaches (called primary stabbing headache now in the International Headache Diagnostic Criteria) are defined as either a single stab or a series of stabs felt in the orbital region (around or behind your eye), temporal area, or parietal area of the head. (The parietal area is behind the temporal area.) Stabs occur with irregular frequency. On days that they occur, they may occur only once, or may occur many times per day, but with no regularity. Duration of stabs is short, usually a few seconds.

So, what does an ice pick headache feel like? Well, pretty much like it sounds—like an ice pick suddenly jabbing into your head without warning. The pain is often sharp and severe, and most people who have had these headaches are glad they don't last very long.

Stabbing headache or ice pick headaches can occur as an isolated headache type, but occur more commonly in migraine or cluster headache sufferers. The pain experienced can be very intense, and tends to hit without warning. If you experience tears, redness of the eye, and nasal stuffiness in conjunction with stabbing pains in the temporal region or the orbital region, it is likely that you have a rare headache type known as SUNCT (Short-lasting Unilateral Neuralgiform headache attacks with Conjuctival injection and Tearing), which is one of the Trigeminal Autonomic Cephalgias. Another condition that needs to be ruled out is trigeminal neuralgia, which causes facial pain and can sometimes feel like a jolt in the face.

Headache textbooks tend to be somewhat dismissive of stabbing headache, indicating that reassurance should be offered, since this headache type does not indicate underlying pathology such as a tumor or aneurysm. This, however, is not terribly helpful to the sufferer who is experiencing the sensation of needles, ice picks, spikes, or tiny knives being jabbed into their head on a recurring but unpredictable basis.

Some sufferers of stabbing headaches indicate that they started to experience them in childhood. Most attacks of ice pick headache occur randomly and without warning, although some sufferers have identified emotional or other stressors as triggers. Other than stress, triggers of ice pick headache have not been clearly identified.

Treatment for Icepick Headaches

Treatment is problematic, since the attacks are so short. In some cases, indomethacin taken preventatively will be helpful, but this is by no means universally so. Some migraine sufferers who also experience ice pick headaches report that the stabbing headaches improve with better control of their migraines. A small case series (three patients) reported benefit for ice pick headache from melatonin. As with many headache types, more information is needed before we more fully understand the underlying causes and can offer a meaningful solution.

References

1. Rozen, TD. Melatonin as treatment for idiopathic stabbing headache. Neurology. 2003; 61:865-866.

2. Raskin, NH, Schwartz, RK. Icepick-like pain. Neurology. 1980 Feb;30(2):203-5.