Primary stabbing headache

Rashmi B Halker Singh MD (Dr. Halker Singh of the Mayo Clinic in Phoenix, Arizona, has no relevant financial relationships to disclose.)
Shuu-Jiun Wang MD, editor. (Dr. Wang of the National Yang-Ming University School of Medicine and the Neurological Institute, Taipei Veterans General Hospital received consulting fees from Eli Lilly and Daichi-Sankyo.)
Originally released September 2, 1994; last updated March 7, 2018; expires March 7, 2021

This article includes discussion of primary stabbing headache, previously known as idiopathic stabbing headache, icepick-like pains, jabs and jolts syndrome, needle-in-the-eye syndrome, ophthalmodynia periodica, and sharp short-lived head pains. The discussion will include a review of symptoms, diagnostic workup, and management.


The author overviews the clinical symptoms, classification, etiology, and treatment of idiopathic stabbing headaches. Indomethacin is the main therapeutic option for this type of headache, but melatonin has been shown to be effective in some cases. Idiopathic stabbing headache can be a primary headache, but it is usually associated with another primary headache disorder.

Key points


• Primary stabbing headache is usually a benign self-limited primary headache disorder, consisting of sharp stabs of pain predominantly felt in the first division of the trigeminal nerve.


• Imaging is reasonable to exclude secondary causes.


• Indomethacin is the first-line treatment for primary stabbing headache.


• Other therapeutic options include melatonin, gabapentin, and celecoxib.

Historical note and terminology

Primary stabbing headache was first described in 1964, at which time it was called "ophthalmodynia periodica" (Lansche 1964). Since then, brief, sharp, jabbing pains that occur either as single episodes or in repeated flurries have been designated by various terms including: "icepick-like pains," "sharp short-lived head pains," "needle-in-the-eye syndrome," and "jabs and jolts syndrome" (Raskin and Schwartz 1980; Sjaastad et al 1980; Mathew 1981; Spierings 1990). The International Classification of Headache Disorders, 3rd edition, uses the term "primary stabbing headache," classified under item 4—other primary headaches.

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