These startling, sometimes frightening head pains 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 "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 (IHS) criteria, the official name for them is "primary stabbing headache. Other terms that have been used are idiopathic stabbing headache jabs and jolts, ophthalmodynia, and periodica. Ice pick headaches is probably the most commonly used term because it's the most descriptive. The IHS description reads:

"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."

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.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 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.
  

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.

Last Updated July 10, 2004