What to Know About Ice Pick Headache (Primary Stabbing Headache)

Medically reviewed by: Christina Duffy Henriques, APRN, AQH

What is Ice Pick Headache?

Ice pick headache is a type of headache disorder characterized by a short burst of sharp and stabbing head pain that comes on fast.¹ Attacks are brief, lasting a few seconds.¹

The pain feels like someone is piercing your head with an ice pick or some other sharp, pointed object.

Clinically, it is called primary stabbing headache. Other names include: ice-pick pains, jabs and jolts, needle in the eye syndrome – known as Ophthalmodynia periodica.

Ice Pick Headache Symptoms

An ice pick headache is short, typically lasting less than 3 seconds.¹ The jolt of pain can occur anywhere on the head. Most people feel it on their forehead, temples, or around their eyes and ears. People may feel them on one or both sides of the head. However, people with migraine tend to experience the stabs on the same side as their head pain from a migraine attack.¹

Usually, the jabs are felt in different areas, not always in the same spot. A person can have one or many stabs per day. The timing can be irregular and unpredictable. 

Unlike SUNCT or SUNA, ice pick headaches don’t cause cranial autonomic symptoms like red or watery eyes, a stuffy or runny nose, ear pressure, or flushing.¹ 

Light or sound sensitivity, nausea, and dizziness may occur for some people.²

Who Gets Ice Pick Headaches

Anyone can have ice pick headaches. They are more common in adults in their 40’s, women, and people with migraine, cluster headache, or hemicrania continua.^1,3,4

While rare, children can also experience ice pick headaches. The stabs are reported to occur for a longer period of time, but happen less frequently in kids than in adults.⁵ They typically begin between ages 4 and 9. They may occur more often in girls than in boys.⁵ Most children have a parent with a family history of a primary headache disorder, such as migraine.⁵ The majority have another condition, such as infantile colic, benign paroxysmal vertigo, motion sickness, recurrent abdominal pain, or cyclic vomiting.⁵ These children commonly present with a normal neurological exam. 

Treatment Options to Manage Ice Pick Headaches

Because attacks are so short, most people don’t seek treatment. Still, it’s important not to dismiss symptoms or self-diagnose. Talk to your doctor about what you’re experiencing, and know that treatment is an option. 

Indomethacin is the standard treatment for severe and frequent attacks.⁶ The dose can range from 75 to 250 mg a day. It may be used “off-label” in teens aged 15 or older.⁶

Other treatment options include:^2,6,7

• A Cox-2 inhibitor such as Celecoxib
• OnabotulinumtoxinA
• Melatonin (may be used in kids)
• Prednisolone
• Gabapentin
• Topiramate
• Amitriptyline
• Acetazolamide
• Nifedipine

Some of these treatments have not been well-studied in large populations.

Ruling Out Other Conditions

Before diagnosing ice pick headache, a healthcare provider will run tests to exclude other conditions. The symptoms can overlap with vascular problems, tumors, certain infections, such as herpes, and with autoimmune disorders, like lupus or multiple sclerosis. A clinician may order blood work and/or an MRI or CT scan². Neuroimaging is necessary when clinical features do not match the typical features of this condition. 

A healthcare provider will also rule out other headache conditions, such as SUNCT, SUNA, trigeminal neuralgia, paroxysmal hemicrania, and hemicrania continua.

It is important to seek emergency care (911/ER) for headaches with fever, stiff neck, confusion, weakness, vision changes, or if it feels like the “worst/sudden” headache. Also, see a healthcare provider promptly if the frequency increases after age 50, symptoms worsen, or occur after trauma. 

Seeking Help

Ice pick headaches, formally known as Primary Stabbing Headaches (PSH), can be sudden, sharp, and alarming, lasting only 1-3 seconds. Talk to your healthcare provider if you experience these symptoms. They can help determine a cause, whether it’s ice pick headache or something else. A neurologist, particularly a headache specialist, is the best provider for diagnosing and treating this type of headache disorder.

Keeping a headache diary can help your healthcare provider better understand your headaches and identify patterns. Note how often they happen, where the pain is, how long each attack lasts, and anything that might trigger them. Sharing this information with your provider can help you work together to find the most effective treatment plan.

References

1. https://ichd-3.org/other-primary-headache-disorders/4-7-primary-stabbing-headache/
2. https://doi.org/10.1007/s11910-019-0955-6
3. https://headachejournal.onlinelibrary.wiley.com/doi/10.1111/head.14915
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC12532831/
5. https://pubmed.ncbi.nlm.nih.gov/38215234/
6. https://link.springer.com/article/10.1007/s11910-019-0955-6
7. https://e-hpr.org/journal/view.php?number=906

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