What are Ice Pick Headaches?
Ice pick headache, also known as primary stabbing headaches or ophthalmodynia periodica, is a type of headache characterised by sudden, sharp bouts of pain.[1] As the name suggests, the pain is often described as a stabbing pain, like from an ice pick. Ice pick headaches often come without warning, and last only a couple of seconds. It may occur in one part of the head, but can move or occur in multiple different parts.
Ice pick headaches are considered as primary headaches, meaning they are not a symptom of something else, but their own condition.[2] This contrasts to secondary headaches, which are a symptom of an underlying condition, such as vascular disorder or tumour.
The symptoms of ice pick headaches can be confused with other conditions, so it is important to distinguish between the causes.[3]
What are the symptoms of an ice pick headache?
Ice pick headaches are characterised by several symptoms, including:
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A single sharp pain or quick bouts of pain
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Pain is usually on one side of the head, but may move
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Pain lasts for a few seconds at various frequencies
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Sudden onset of pain, often without warning
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Often experienced around the eyes or temples, but also the top, front, or sides of the head
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Neck, shoulder, or arm stiffness.
What causes ice pick headaches?
The exact cause of ice pick headaches has not been established. There are some suggestions that the pain originates from nerve dysfunction or disrupted pain mechanisms.
The triggers of ice pick headaches may include:
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Disrupted sleep
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Stress
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Alcohol
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Foods or food additives
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Bright lights.
Diagnosing ice pick headaches
Ice pick headaches can be difficult to diagnose as they often present in a similar way to other conditions. A health practitioner will ask about the symptoms, location, and history of the pain. A physical examination will also be used to assess various structures in the body. Further testing such as MRI or blood tests may also be required, however not always.
As part of this process, a doctor will also rule out other underlying conditions that have similar symptoms to ice pick headaches.
1. Migraine
Migraines are headaches that can often be debilitating. Symptoms may include visual auras, nausea, and sensitivity to light. Pain may last for hours or days.
2. Cluster headaches
Headaches that occur in a series of clusters are called cluster headaches, and can occur from weeks to months. They can also affect sleeping patterns.
3. Tension headaches
A tension headache causes a feeling of tension in the head, sometimes described as a tight band around the head.
4. Cervicogenic headaches
Cervicogenic headaches are headaches caused by musculoskeletal problems in the neck or shoulders, which cause radiating or referred pain to the head.
5. Neuralgia
This is a term that describes pain along a nerve pathway, and can cause headaches.
6. Shingles
Shingles is caused by a viral infection in the nerves. It often has a characteristic rash, and can also cause headaches.
7. Vascular disorders
Vascular disorders can cause headaches. This is a medical emergency, as vascular disorders can lead to stroke or death.
8. Tumour
A tumour can cause headaches, often worsening over time. Immediate medical input is required.
Other differential diagnoses may include Bell’s palsy, infection, or autoimmune disorders. It is essential to rule out any severe underlying causes or medical emergencies before any treatment is considered.
How are ice pick headaches treated?
Treatment for ice pick headaches depends on the cause, severity, and location of the symptoms. They may resolve on their own, or persist over time.
Ice pick headaches often disappear quickly. Therefore, the window of opportunity to take medication is small. Instead, a doctor may prescribe prophylactic medication to help prevent the headaches from occurring, or lessen the symptoms if they do occur.
A doctor can determine the appropriate medication, depending on the cause and symptoms. Some medications may include non-steroidal anti-inflammatory drugs (NSAIDs), melatonin, or neurotransmitter inhibitors. In some cases, people with ice pick headaches may not respond to medications.
If ice pick headaches are occurring frequently or interfering with daily life, a health practitioner may recommend a combination of treatments.
Treatments may also include:
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Rest
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Maintaining a healthy diet and exercise regime
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Avoiding any identified triggers
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Dry needling or acupuncture
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Mindfulness or stress management.
It may also be helpful to keep a diary of any symptoms to help the doctor determine if there is a pattern or if there are any specific triggers.
When to see a doctor
If the pain is severe, persistent, or worsening with time, it is important to consult a doctor. Headaches can also be a secondary symptom related to an underlying medical condition, such as vascular disorders or tumours. It is therefore important to be aware of any red flags that may require emergency medical input.
Red flags can include:
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Facial droop
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Chest pain
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Sudden weakness
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Numbness or tingling
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Loss of bladder or bowel control
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Drowsiness or loss of consciousness
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Vision or hearing changes
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Seizures
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Any other unexplained symptoms.
Key takeaways
Headaches are a common experience. Ice pick headaches may occur suddenly, often without warning. The exact cause of ice pick headaches is not yet known.
A doctor may recommend a combination of treatments, depending on the cause and symptoms. It is important to see a doctor to rule out any other causes of the headaches as the symptoms may be similar to a serious underlying medical condition that requires emergency input.
