Ice Pick Headache (Primary Stabbing Headache)

An ice pick headache is an uncommon headache disorder. It causes a sudden, sharp, stabbing head pain (or a quick series of pains). This pain comes on unexpectedly and lasts a few seconds.

Headache: When to worry, what to do

Understanding what causes headaches and finding treatments to relieve the pain

Nearly everyone has had headache pain, and most of us have had it many times. A minor headache is little more than a nuisance that’s relieved by an over-the-counter pain reliever, some food or coffee, or a short rest. But if your headache is severe or unusual, you might worry about stroke, a tumor, or a blood clot. Fortunately, such problems are rare. Still, you should know when a headache needs urgent care and how to control the vast majority of headaches that are not threatening to your health.

What causes headaches?

Doctors don’t fully understand what causes most headaches. They do know that the brain tissue and the skull are never responsible since they don’t have nerves that register pain. But the blood vessels in the head and neck can signal pain, as can the tissues that surround the brain and some major nerves that originate in the brain. The scalp, sinuses, teeth, and muscles and joints of the neck can also cause head pain.

When to worry about a headache

You can take care of many types of headaches by yourself, and your doctor can give you medication to control most of the tougher headaches. But some headaches call for prompt medical care. Here are some warning signs for when you should worry about headaches:

  • Headaches that first develop after age 50
  • A major change in the pattern of your headaches
  • An unusually severe headache
  • Head pain that increases with coughing or movement
  • Headaches that get steadily worse
  • Changes in personality or mental function
  • Headaches that are accompanied by fever, stiff neck, confusion, decreased alertness or memory, or neurological symptoms such as visual disturbances, slurred speech, weakness, numbness, or seizures
  • Headaches that are accompanied by a painful red eye
  • Headaches that are accompanied by pain and tenderness near the temples
  • Headaches after a blow to the head
  • Headaches that prevent normal daily activities
  • Headaches that come on abruptly, especially if they wake you up
  • Headaches in patients with cancer or impaired immune systems

Types of headaches

There are more than 300 types of headaches, but only about 10% of headaches have a known cause. The others are called primary headaches. Here is a rundown on some major primary headaches.

Tension headaches

Occurring in about three of every four adults, tension headaches are the most common of all headaches. In most cases, they are mild to moderate in severity and occur infrequently. But a few people get severe tension headaches, and some are troubled by them for three or four times a week.

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The typical tension headache produces a dull, squeezing pain on both sides of the head. People with strong tension headaches may feel like their head is in a vise. The shoulders and neck can also ache. Some tension headaches are triggered by fatigue, emotional stress, or problems involving the muscles or joints of the neck or jaw. Most last for 20 minutes to two hours.

If you get occasional tension-type headaches, you can take care of them yourself. Over-the-counter pain relievers such as acetaminophen (Tylenol, other brands) and nonsteroidal anti-inflammatories (NSAIDs) such as aspirin, naproxen (Aleve, other brands), or ibuprofen (Motrin, Advil, other brands) often do the trick, but follow the directions on the label, and never take more than you should. A heating pad or warm shower may help; some people feel better with a short nap or light snack.

If you get frequent tension-type headaches, try to identify triggers so you can avoid them. Don’t get overtired or skip meals. Learn relaxation techniques; yoga is particularly helpful because it can relax both your mind and your neck muscles. If you clench your jaw or grind your teeth at night, a bite plate may help.

If you need more help, your doctor may prescribe a stronger pain medication or a muscle relaxant to control headache pain. Many people with recurrent tension-type headaches can prevent attacks by taking a tricyclic antidepressant such as amitriptyline (Elavil, generic). Fortunately, most people with tension-type headaches will do very well with simpler programs.

Migraine

Migraines occur less often than tension headaches, but they are usually much more severe. They are two to three times more common in women than men, but that’s small consolation if you are among the 6% to 8% of all men who have migraines. And since a Harvard study of 20,084 men age 40 to 84 reported that having migraines boosts the risk of heart attacks by 42%, men with migraines should take their headaches to heart.

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Neurologists believe that migraines are caused by changes in the brain’s blood flow and nerve cell activity. Genetics play a role since 70% of migraine victims have at least one close relative with the problem.

Migraine triggers. Although a migraine can come on without warning, it is often set off by a trigger. The things that set off a migraine vary from person to person, but a migraine sufferer usually remains sensitive to the same triggers. The table lists some of the most common ones.

Major migraine triggers

  • Changing weather: rising humidity, heat
  • Lack of sleep or oversleeping
  • Fatigue
  • Emotional stress
  • Sensory triggers: bright or flickering lights, loud noises, strong smells
  • Dietary triggers:
    • missing a meal
    • alcohol, especially red wine
    • chocolate
    • nitrates in cured meats and fish
    • aged cheese
    • an increase or decrease in caffeine
    • MSG (often present in Asian and prepared foods)

    Migraine symptoms. Migraines often begin in the evening or during sleep. In some people, the attacks are preceded by several hours of fatigue, depression, and sluggishness or by irritability and restlessness. Because migraine symptoms vary widely, at least half of all migraine sufferers think they have sinus or tension headaches, not migraines.

    About 20% of migraines begin with one or more neurological symptoms called an aura. Visual complaints are most common. They may include halos, sparkles or flashing lights, wavy lines, and even temporary loss of vision. The aura may also produce numbness or tingling on one side of the body, especially the face or hand. Some patients develop aura symptoms without getting headaches; they often think they are having a stroke, not a migraine.

    The majority of migraines develop without an aura. In typical cases, the pain is on one side of the head, often beginning around the eye and temple before spreading to the back of the head. The pain is frequently severe and is described as throbbing or pulsating. Nausea is common, and many migraine patients have a watering eye, a running nose, or congestion. If these symptoms are prominent, they may lead to a misdiagnosis of sinus headaches. One way to remember the features of migraine is to use the word POUND

    P is for pulsating pain
    O for one-day duration of severe untreated attacks
    U for unilateral (one-sided) pain
    N for nausea and vomiting
    D for disabling intensity.

    Without effective treatment, migraine attacks usually last for four to 24 hours. When you’re suffering a migraine, even four hours is far too long — and that’s why early treatment for a migraine is so important.

    Migraine treatment. If you spot a migraine in its very earliest stages, you may be able to control it with nonprescription pain relievers. Acetaminophen, aspirin, ibuprofen, naproxen, and a combination of pain medications and caffeine are all effective — if you take a full dose very early in the attack.

    When prescription drugs are needed, most doctors turn to the triptans, which are available as tablets, nasal sprays, or as injections that patients can learn to give to themselves. Examples include sumatriptan (Imitrex), zolmitriptan (Zomig), and rizatriptan (Maxalt). Triptans provide complete relief within two hours for up to 70% of patients; the response is best if treatment is started early. Some patients require a second dose within 12 to 24 hours. Patients with cardiovascular disease and those who take a high dose of certain antidepressants need to discuss the risks of using them with their doctor.

    Work with your doctor to find the migraine treatment that works best for you. Remember, though, that overuse can lead to rebound headaches and a vicious cycle of drugs and headaches. So, if you need treatment more than two or three times a week, consider preventive medications.

    Migraine prevention. Some people can prevent migraines simply by avoiding triggers. Others do well with prompt therapy for occasional attacks. But patients who suffer frequent migraine attacks often benefit from preventive medications. Effective prescription drugs include beta blockers (such as propranolol, nadolol and atenolol), certain antidepressants (such as amitriptyline), and certain antiseizure medications (such topiramate and valproate). Difficult cases may benefit from referral to a headache specialist.

    Cluster headaches

    Cluster headaches are uncommon but very severe headaches, and they occur five times more often in men than women. Although anyone can get cluster headaches, the typical patient is a middle-aged man with a history of smoking.

    The problem gets its name because the headaches tend to come in clusters, with one to eight headaches a day during a one- to three-month period every year or two, often at the same time of year. The pain always strikes one side of the head and is very severe. The eye on the painful side is red and watery, the eyelid may droop, and the nose runs or is blocked. The attack starts abruptly and lasts for 30 to 60 minutes. Most sufferers become restless and agitated during the attack; unable to sit still, they pace, jog in place, or beat their head against a wall. Nausea and sensitivity to light and sound may accompany the pain.

    Inhaling high flow oxygen soon after the onset of the headache can often stop the attack. Sumatriptan is often effective for cluster headaches, particularly when given by injection. Other triptans may also help. Some patients favor lidocaine nose drops, dihydroergotamine injections, or other treatments. The most effective medication for preventing cluster headache attacks is verapamil, a calcium-channel blocker. Other drugs that may help include divalproex, topiramate, and lithium.

    Other types of headaches

    Doctors have diagnosed hundreds of conditions associated with headaches. Here are just a few:

    Medication headaches. Many drugs number headaches among their side effects. And although it seems paradoxical, many medications used to treat headaches can also cause medication overuse headaches or rebound headaches. Migraine sufferers are particularly vulnerable to a vicious cycle of pain leading to more medication, which triggers more pain. If you have frequent headaches and use medication, OTC or prescription, or both, for more than 10 to 15 days a month, you may have medication overuse headaches. The way to find out is to discontinue or taper your medication — but always consult your doctor first. A corticosteroid such as prednisone may help control pain during the withdrawal period.

    Sinus headaches. Acute sinusitis causes pain over the forehead, around the nose and eyes, over the cheeks, or in the upper teeth. Stooping forward increases the pain. Thick nasal discharge, congestion, and fever pinpoint the problem to the sinuses. When the acute infection resolves, the pain disappears. Sinusitis is not a common cause of chronic or recurrent headaches.

    Ice cream headaches. Some people develop sharp, sudden headache pain when they eat anything cold. The pain is over in less than a minute, even if you keep eating. If you are bothered by ice cream headaches, try eating slowly and warming the cold food at the front of your mouth before you swallow it.

    Headache from high blood pressure. Except in cases of very high blood pressure, hypertension does not cause headaches. In fact, most people with high blood pressure don’t have any symptoms at all, and a study of 51,234 people reported that hypertension was associated with a reduced incidence of headaches. But that’s no reason to neglect your blood pressure. Hypertension leads to strokes, heart attacks, heart failure, and kidney disease, so all men should have their pressure checked, and then take steps to correct abnormalities.

    Headache from exercise and sex. Sudden, strenuous exercise can bring on a headache. Gradual warm-ups or treatment with an anti-inflammatory medication before exercise can help. Sexual intercourse may also trigger headaches; some men note only dull pain, but others suffer from severe attacks called orgasmic headaches. Some people can prevent orgasmic headaches by taking an NSAID 30 to 60 minutes before intercourse.

    Headache testing

    Modern medicine depends on tests to diagnose many problems. For most headaches, though, a good old-fashioned history and physical will do the job. In fact, CT scans, MRIs, and EEGs (brain wave tests) look normal in tension-type headaches, migraines, and cluster headaches. Still, these tests can be vital in patients with warning signs or other worrisome headaches.

    Living with constant headaches

    For most of us, an occasional headache is nothing more than a temporary speed bump in the course of a busy day. Even so, most men can ease the problem with simple lifestyle measures and nonprescription medications. Relaxation techniques, biofeedback, yoga, and acupuncture may also help. But for some of us, headaches are a big problem. Learn to recognize warning signs that call for prompt medical care. Work with your doctor to develop a program to prevent and treat migraines and other serious headaches. And don’t fall into the trap of overusing medications; for some gents, rebound headaches are the biggest pain of all.

    Ice Pick Headache (Primary Stabbing Headache)

    Ice pick headaches are a type of headache disorder that causes unexpected, sharp, stabbing pains. Primary stabbing headaches have no underlying cause. They’re difficult to treat because the pain lasts just a few seconds. You can take steps to prevent headaches.

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    Overview

    What is an ice pick headache (primary stabbing headache)?

    An ice pick headache is an uncommon headache disorder. It causes a sudden, sharp, stabbing head pain (or a quick series of pains). This pain comes on unexpectedly and lasts a few seconds.

    People who have these headaches equate the pain to being stabbed in the head or eye with an ice pick.

    The medical term for ice pick headaches is stabbing headaches. Other terms include:

    • Jabs-and-jolts syndrome.
    • Needle-in-the-eye syndrome.
    • Ophthalmodynia periodica.
    • Sharp, short-lived head pain.

    How common are ice pick headaches?

    Some studies suggest that only about 2% of people worldwide experience these headaches. But one Norwegian study found that 1 in 3 people had ice pick headaches.

    Who is at risk for ice pick headaches?

    People of all ages and genders can get ice pick headaches. Women who get migraine headaches are more prone to them. In 1 in 3 instances, the ice pick headache occurs in the spot where migraine pain originates.

    Symptoms and Causes

    What causes ice pick headaches?

    Experts aren’t sure why some people get ice pick headaches. All types of headaches have primary and secondary causes:

    • Primary headache: People with primary ice pick headaches experience head pain without other symptoms. There isn’t an underlying condition causing the pain.
    • Secondary headache: A health condition, such as shingles, meningioma (brain tumor) or multiple sclerosis, causes the ice pick headache along with other symptoms.

    What are the symptoms of ice pick headaches?

    An ice pick headache may cause a single stabbing pain or a series of quick pains. In 8 out of 10 instances, each stabbing pain lasts less than three seconds.

    These head pains:

    • Happen without warning.
    • Move from front to back (or back to front) on the same side of the head.
    • Move from right to left (or left to right) on either the front or back of the head.
    • Occur sporadically once a day or several times a day. It’s rare to get ice pick headaches over several consecutive days.

    Diagnosis and Tests

    How are ice pick headaches diagnosed?

    Your healthcare provider can diagnose ice pick headaches based on your symptoms. Rarely, ice pick headaches are a sign of an underlying problem like a brain tumor.

    Your provider may order an MRI or another imaging test to check for health conditions. But most people with ice pick headaches don’t need this type of testing.

    Your healthcare provider will also want to rule out other headache disorders that cause similar symptoms. These include:

    • Nummular headache: This headache causes pressure-like pain in a coin-shaped spot in the head.
    • Occipital or cranial neuralgias: Inflamed occipital nerves in the scalp cause occipital neuralgia. You may have shock-like pain in the back of the head, behind the ears or the upper neck.
    • Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT): This rare headache disorder causes pain around one eye. The eye becomes red and watery (conjunctivitis). You may also have a runny nose and nasal congestion.
    • Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA): Similar to SUNCT, this disorder causes eye pain with or without redness and tearing. With SUNA, an eye may be red but not watery. Or the eye may be watery but not red.
    • Trigeminal neuralgia: Nerve inflammation causes pain like electrical shocks to the lower face and jaw. People with trigeminal neuralgia may also have pain around the nose and above the eyes.

    Management and Treatment

    How are ice pick headaches managed or treated?

    Ice pick headaches disappear quickly. They aren’t like other headaches or migraines, which can last for hours or linger for days.

    There isn’t time to take pain relievers to treat ice pick headaches. By the time the medicine kicks in, the ice pick headache is long gone.

    Instead, treatments focus on preventing pain. Preventive steps include:

    • Headache medications taken daily to ward off head pain like migraines.
    • Melatonin to reduce migraine frequency.
    • Prescription nonsteroidal anti-inflammatory drugs (NSAIDs), such as indomethacin (Tivorbex®), to minimize headache pain when it occurs.

    Prevention

    How can I prevent an ice pick headache?

    The same steps you might take to prevent other headaches or migraines may also lower your risk of ice pick headaches. Don’t overdo it with pain medicine. You can develop medication overuse or rebound headaches.

    • Eat a healthy diet and try not to skip meals.
    • Get more sleep.
    • Limit your caffeine and alcohol.
    • Manage stress through exercise and relaxation techniques like yoga and meditation.
    • Quit smoking and using other tobacco products.
    • Try therapies like biofeedback or acupuncture.

    Outlook / Prognosis

    What is the prognosis (outlook) for people who have ice pick headaches?

    Ice pick headaches come and go quickly. They aren’t as debilitating as chronic migraines or headaches. Still, you should see your healthcare provider if head pain lasts several days or interferes with your ability to work or complete daily activities.

    Living With

    When should I call the doctor?

    You should call your healthcare provider if you experience stabbing head pain and:

    • Balance problems.
    • Dizziness.
    • Nausea and vomiting.
    • Vision problems.

    What questions should I ask my doctor?

    You may want to ask your healthcare provider:

    • What is causing my head pain?
    • How can I prevent ice pick headaches?
    • What is the best treatment for me?
    • Should I look out for signs of complications?

    A note from Cleveland Clinic

    Because ice pick headaches happen sporadically and go away so quickly, many people don’t tell their healthcare providers about them. But these headaches may be more than a painful nuisance. In rare instances, they’re a sign of a more serious problem. You should share your symptoms with your provider. They can find what’s causing the pain and work with you to prevent head pains.

    Last reviewed by a Cleveland Clinic medical professional on 08/25/2021.

    References

    • American Association of Neurological Surgeons. Occipital Neuralgia. (https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Occipital-Neuralgia) Accessed 11/23/2021.
    • American Migraine Foundation. Preventive Treatments. (https://americanmigrainefoundation.org/resource-library/understanding-migrainepreventive-treatments/) Accessed 11/23/2021.
    • American Migraine Foundation. Primary Stabbing Headache (Ice Pick Headache). (https://americanmigrainefoundation.org/resource-library/ice-pick-headaches/) Accessed 11/23/2021.
    • Chua AL, Nahas S. Ice pick headache. (https://pubmed.ncbi.nlm.nih.gov/27038969/) Curr Pain Headache Rep. 2016;20(5). Accessed 11/23/2021.
    • Ferrante E, Rossi P, Tassorelli C, Lisotto C, Nappi G. Focus on therapy of primary stabbing headache. (https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1007/s10194-010-0189-0) J Headache Pain. 2010;11:157-160. Accessed 11/23/2021.
    • Lyon C, Langner S. PURLs: Consider melatonin for migraine prevention. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5432214/) J Fam Pract. 2017;66(5):320-2. Accessed 11/23/2021.
    • Merck Manual. Short-Lasting Unilateral Neuralgiform Headache Attacks With Conjunctival Injection and Tearing. (https://www.merckmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/headaches/short-lasting-unilateral-neuralgiform-headache-with-conjunctival-injection-and-tearing-sunct) Accessed 11/23/2021.
    • The International Classification of Headache Disorders 3rd Edition (ICHD-3). Primary Stabbing Headache. (https://ichd-3.org/other-primary-headache-disorders/4-7-primary-stabbing-headache/) Accessed 11/23/2021.
    • National Headache Foundation. Case Studies in Headache Archive: Icepick Headache. (https://headaches.org/2010/03/12/case-studies-icepick-headache/) Accessed 11/23/2021.
    • Pareja JA, Pareja J. Nummular headache: Diagnosis and treatment. (https://pubmed.ncbi.nlm.nih.gov/19810895/) Expert Rev Neurother. 2003;3(3):289-92. Accessed 11/23/2021.
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