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  • Updated 03.29.2024
  • Released 09.02.1994
  • Expires For CME 03.29.2027

Primary stabbing headache



Primary stabbing headache presents as abrupt, ultrashort-lasting (less than 3 seconds), focal or multifocal stabs of pain in the head that might occur sporadically or in clusters. According to criteria from The International Classification of Headache Disorders, 3rd edition, the sharp stabbing pain is no longer restricted to the first division of the trigeminal nerve. Patients, especially children, reported stab durations longer than a few seconds, which may indicate that ICHD-3 criteria need to be adjusted. 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. The differential diagnosis should include secondary etiologies for stabbing headaches.

Key points

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

• Age, gender, and whether the headache is comorbid with migraine influence the frequency of primary stabbing headache.

• 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" (17). 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" (30; 35; 20; 38; 24). 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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