What are the other Names for this Condition? (Also known as/Synonyms)

• Idiopathic Stabbing Headache
• Primary Stabbing Headache
• Short-Lived Head Pain Syndrome

What is Ice Pick Headache? (Definition/Background Information)

• Ice Pick Headaches are very short duration stabbing pains typically felt in the front and sides of the head that may be moderately severe to excruciatingly intense. These headaches tend to ‘come and go’ a few times during the day and night
• Based on the underlying cause, Ice Pick Headaches are classified as primary or secondary:
  • Primary cases are not associated with an identified cause and the headache in itself may be the main issue. These are termed Primary Stabbing Headaches or Idiopathic Stabbing Headaches
  • Secondary cases are associated with a variety of underlying causes including brain stroke and herpes zoster infection
• The exact cause of Ice Pick Headache is not clearly known, but it is believed to be associated with anomalies in the pain control mechanism of the brain. Many cases are observed in individuals with migraine headaches
• Apart from the stabbing headaches, individuals may also have nausea, vomiting, and even dizziness. Severe and prolonged Ice Pick Headaches can disrupt one’s daily life and work/activities
• Prolonged cases and Ice Pick Headaches that occur regularly usually require treatment. The healthcare provider may prescribe medications, such as melatonin and non-steroidal anti-inflammatory drugs, towards treating the condition
• Even though it may be difficult to predict the occurrence of Ice Pick Headaches, the prognosis for the condition is generally good. Addressing some of the triggers of the condition, such as stress and bright lights, may help in avoiding the stabbing headaches

Who gets Ice Pick Headache? (Age and Sex Distribution)

• Ice Pick Headaches are mostly observed in females (average age 28 years), affecting anywhere between 1 in 3 women to 1 in 50 women worldwide
• Some reports inform that the condition is prevalent in adults over 45 years of age; typically, individuals first report the condition between the ages of 45 and 50
• The condition is also known to affect children and adolescents
• Individuals of all racial and ethnic groups may be affected

What are the Risk Factors for Ice Pick Headache? (Predisposing Factors)

Some known risk factors for Ice Pick Headache may include:

• Individuals with migraine headaches (the pain often occurs at the same spot as the migraine headache)
• Individuals with cluster headaches

The following factors are known to trigger Ice Pick Headaches in some individuals:

• Stress
• Poor or disrupted sleep
• Bright lights
• Sudden motion or movement
• Hormonal changes in the body
• Alcohol consumption; typically, red wine is known to trigger the condition in some individuals
• Use of certain food additives

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Ice Pick Headache? (Etiology)

The exact cause of Ice Pick Headache is not clearly known or understood.

• It is believed that individuals experience the intense stabbing pain due to some short-term dysfunction or disruption in the way the brain receives and sends pain signals
• Research studies indicate that it is not associated with any disease or trauma to the head

Primary Ice Pick Headaches are not caused by an underlying condition; hence, it is also denoted as idiopathic. The cause of Secondary Ice Pick Headaches is many and varied and include:

• Bell’s palsy
• Herpes zoster meningoencephalitis
• Meningioma
• Multiple sclerosis
• Shingles
• Stroke

What are the Signs and Symptoms of Ice Pick Headache?

The common signs and symptoms of Ice Pick Headache may include:

• Sudden jolts of stabbing pain, usually involving the frontal lobe or temporal lobe region of the brain (region at the top, sides, or front of the head, including the temples)
• The pain may consist of a single stabbing pain or multiple pain stabs
• Often, several areas of the head may present pain points; but each time, only one location is involved
• The stabbing pain may last anywhere between 3-10 seconds; over 80% of them last less than 3 seconds
• It normally occurs two to three times a day (but may even go up to 50 times per day) and at any time of the day or night; the frequencies are usually irregular
• The pain instances may occur together for many hours and then cease completely. They may be moderate-to-severe, and are usually very painful

In many individuals, the condition is seen along-with the following symptoms:

• Nausea and vomiting
• Light-sensitivity
• Dizziness

Signs and symptoms of the underlying condition, if any, causing the stabbing headaches, may also be noted.

How is Ice Pick Headache Diagnosed?

A diagnosis of Ice Pick Headache is made based on the information gathered from the following:

• Complete physical examination and assessment of the presenting signs and symptoms
• Thorough analysis of personal and family medical history, including one’s history of migraine (if any)
• Neurological examination by a qualified healthcare provider
• Imaging tests such as MRI and CT scans (of the head and neck region)
• Differential diagnosis to rule out other conditions that may manifest with similar signs and symptoms such as:
  • Nummular headache
  • Occipital neuralgia (or other cranial neuralgias)
  • Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)
  • Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA)
  • Trigeminal neuralgia

Note: An absence of cranial autonomic symptoms, such as tearing from the eyes, flushing of the face, or droopy eyelids, is important in establishing a diagnosis of Ice Pick Headaches.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Ice Pick Headache?

The complications of Ice Pick Headache may include the following:

• In some cases, the stabbing headaches may be excruciatingly painful
• Inability to function in regular activities, resulting in decreased quality of life
• Poor performance at work
• Risk for accidents while driving or operating machinery
• Complications that arise from an underlying condition, if any present
• Side effects of medications used

How is Ice Pick Headache Treated?

In a majority of cases, due to the sudden onset of Ice Pick Headache and its fleeting nature, taking medications for the same is difficult (during the headache attacks). However, if the attacks are frequent and some pattern is recognized, the affected individuals may take suitable prophylactic/preventive measures, such as pain medication, where possible.

The following medications may be prescribed by the healthcare provider:

• Non-steroidal anti-inflammatory drugs (NSAIDs), such as indomethacin, as preventative medication. In nearly 65% of the individuals, indomethacin is known to be quite effective in addressing the condition
• Melatonin hormone (for prophylactic use)
• Gabapentin, to treat nerve pain
• Cyclooxygenase-2 inhibitors

Other treatment methods that may be used include:

• External hand-warming techniques
• Acupuncture

Additionally, treatment for the underlying condition, if any, causing the headache is necessary.

How can Ice Pick Headache be Prevented?

Presently, it is difficult to prevent the onset of Ice Pick Headaches, because the cause is not yet identified, and these headaches are known to develop suddenly. However, the following points may be considered:

• Keeping a diary to record the headache episodes on a regular basis; also keeping a record of any other associated symptoms that may occur with the headaches
• Keeping track of any triggering factors including noting down all daily activities that one is a part of
• Avoiding such triggering factors that have been identified previously
• Regular medical screening at periodic intervals with tests and physical examinations are recommended, including an annual eye checkup

What is the Prognosis of Ice Pick Headache? (Outcomes/Resolutions)

• The prognosis for Ice Pick Headache is typically good, especially if they are not associated with any other underlying conditions
• If they are associated with an underlying condition, then the overall prognosis depends upon the severity of the underlying causative condition
• In some individuals, treatment measures may not be necessary if the headache episodes are infrequent and last for very short durations. However, this is considered only after a careful evaluation by the healthcare provider

Additions and Relevant Useful Information for Ice Pick Headache:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/health-topics/neurological-institute/