Primary stabbing headache

Rashmi B Halker Singh MD (

Dr. Halker Singh of the Mayo Clinic received honorariums from Allergan and Biohaven for advisory board membership.

)
Shuu-Jiun Wang MD, editor. (

Dr. Wang of the Brain Research Center, National Yang-Ming University, and the Neurological Institute, Taipei Veterans General Hospital, received consulting fees from Eli Lilly, Daichi-Sankyo, and Novartis.

)
Originally released September 2, 1994; last updated February 13, 2019; expires February 13, 2022

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.

Overview

The author overviews the clinical symptoms, classification, etiology, and treatment of primary stabbing headache. Indomethacin is the main therapeutic option for this type of headache, but melatonin has been shown to be effective in some cases. Primary stabbing headache can occur in isolation, but it is frequently comorbid with another primary headache disorder such as migraine.

Key points

 

• Primary stabbing headache is usually a benign self-limited primary headache disorder, consisting of sharp stabs of head pain.

 

• 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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