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Case Studies in Headache Archive: Icepick Headache

“Icepick” Headache Occur in About 2% of Population

By Anne Walling, M.D.
Professor, Family and Community Medicine, University of Kansas School of Medicine – Wichita

THE CASE
Sometimes physicians make diagnoses in the produce aisle! I bumped into Mike, one of my patients, while grocery shopping. During our brief chat, he winced in pain about three times over approximately a two-minute period. Each episode was no more than a fleeting grimace, lasting less than a second.

I knew Mike to be a very healthy young man apart from occasional migraines. When I asked him if he had a headache or any other symptoms, he described having sudden “flashes” of pain in his right temple. He had no other symptoms and otherwise felt fine. He appeared, spoke and acted normally. Mike recalled having a similar pain on one occasion about six weeks previously. That episode had lasted less than five minutes and had consisted of approximately five flashes of pain. Mike was unsure if a migraine attack had followed the previous episode.

Mike made an office appointment and the first thing we did was rule out a serious brain condition by doing a combination of medical history, repeated careful physical examinations and tests including imaging. The most likely diagnosis was “icepick headache,” so named because the pain is typically described as like being stabbed with an ice pick or a needle. When he was offered this diagnosis, Mike said, “That’s it exactly!”

After a long discussion, Mike decided that his icepick headaches were mainly a nuisance, so he decided not to take any specific treatment. His icepick headaches have only recurred once in the 18 months since that meeting in the grocery store.

DISCUSSION
Icepick is one of an unusual group of headaches known as idiopathic stabbing headaches. As the name implies, icepick headaches are sharp episodes of pain that last less than a second and are localized in the eye or temple area. The pain may occur only once or as a series of stabs. It can happen any time of day or night. Sometimes icepick headaches are called “jabs and jolts” if the pain is more than transient, but still lasts less than one minute.

Icepick headaches are estimated to occur in about 2% of the population but are more common in people who have migraine or cluster headaches. In some patients, icepick headache occurs before or during a migraine attack. Usually, however, they occur by themselves rather than during an attack. The headaches are uncommon in children and adolescents.

The cause of icepick headache is unknown but it is believed to result from transient breakdowns in the brain’s central pain control mechanisms. The diagnosis depends on a combination of the patient’s report of the characteristic symptoms plus careful exclusion of other conditions that can cause this type
of pain.

The pain of icepick headache is so brief that it is gone before treatment can take effect. Some patients report improvement from taking indomethacin as a preventive measure, but this treatment has not been studied in large trials. Indomethacin can cause bleeding from the stomach so it should only be used after discussion with a healthcare professional. In many cases, icepick headaches disappear spontaneously.

While icepick headaches are not dangerous, a similar type of pain can be caused by serious conditions such as trigeminal neuralgia, cluster headaches or certain brain conditions. It is important to rule out alternative causes of brief stabbing headaches. If you’re experiencing symptoms that sound like icepick headaches, make an appointment with your physician to confirm the diagnosis.



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