Primary stabbing headache

Rashmi B Halker Singh MD (

Dr. Halker Singh of the Mayo Clinic received honorariums from Supernus for advisory board membership and research support from Amgen and Eli Lilly as an investigator.

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 12, 2020; expires February 12, 2023

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 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.

The content you are trying to view is available only to logged in, current MedLink Neurology subscribers.

If you are a subscriber, please log in.

If you are a former subscriber or have registered before, please log in first and then click select a Service Plan or contact Subscriber Services. Site license users, click the Site License Acces link on the Homepage at an authorized computer.

If you have never registered before, click Learn More about MedLink Neurology  or view available Service Plans.

Find out how you can join MedLink Neurology