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An ice pick headache is a type of headache marked by brief jolts of pain. It most commonly affects the front and sides of the head.

Doctors sometimes refer to this condition as idiopathic stabbing headache, primary stabbing headache (PSH), or ophthalmodynia periodica.

An ice pick headache can present as a sharp pain, a throbbing sensation, or a dull ache. It can develop gradually or come on suddenly, and it can last for a short period of time or for several days.

This article summarizes the common causes of an ice pick headache and some typical symptoms. It also covers diagnosis, treatment, and how it differs from migraine.

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Researchers do not always know the exact cause of an ice pick headache. For each person who gets these headaches, the cause may vary.

Researchers theorize that these headaches develop because of chemical activity in the brain, nerves, or blood vessels surrounding the skull. The muscles in the head and neck may also play a role.

In some cases, people may have a gene that makes them prone to developing headaches. This is more common in people who also have a history of migraine.

The underlying trigger may be idiopathic, which means spontaneous or unknown. In other cases, there may be specific triggers that are either primary or secondary.

Primary triggers

Certain lifestyle factors may trigger ice pick headaches, including:

  • changes in one’s sleep pattern or a lack of sleep
  • cold or heat
  • fatigue
  • alcohol consumption

Secondary triggers

Although doctors may refer to ice pick headaches in general as PSH, the condition can also have secondary triggers. In this scenario, the headache is a symptom of an underlying condition.

Some conditions that may be related to stabbing pain headaches include:

  • herpes zoster meningoencephalitis, which is a complication of shingles
  • stroke
  • multiple sclerosis
  • meningioma, which is a type of noncancerous tumor

The pain associated with ice pick headaches tends to last for only a few seconds. In some people, however, it may last for up to 1 minute.

The headache may also move from one area to another on either the same or opposite side of the head.

Since ice pick headaches often occur in people who also get migraine episodes, migraine sometimes occurs with ice pick headaches.

Ice pick headaches vs. migraine headaches

Although ice pick headaches and migraine can sometimes occur together, this is not always the case, and these conditions are not the same. When they do occur together, a person may experience a mixture of symptoms of both.

Migraine can cause recurrent episodes of moderate-to-severe pain. A person may describe the pain as throbbing or pulsing, and it typically affects one side of the head.

People who experience migraine episodes often also experience other symptoms, such as sensitivity to light and sound. Many people also experience nausea and vomiting.

Although the symptoms of migraine differ from those of ice pick headaches, some similar primary factors can trigger both types of headache, including:

  • anxiety
  • a lack of food or sleep
  • exposure to light
  • alcohol or caffeine consumption
  • hormonal changes (in women)

A migraine episode can last for hours to days. The pain can become so unbearable that it is disabling. Some people may also experience warning signs — such as an aura, flashes of light, blind spots, or tingling sensations — beforehand, but this is not always the case.

People often compare migraine headaches to other types of headaches, but it is important to note that migraine is more than just a bad headache. It is actually a neurological condition.

According to the Migraine Research Foundation, migraine is the third most prevalent and sixth most disabling illness in the world. It affects around 39 million people in the United States. It is also worth noting that migraine is more common in women than in men, affecting about 28 million U.S. women.

Sign of a stroke

A headache can be a warning sign of something more serious, such as a stroke or meningitis. A person should always seek medical help if a headache develops after they sustain a blow to the head.

A severe headache requires immediate medical attention when it is accompanied by any of the following:

According to the diagnostic guidelines of The International Classification of Headache Disorders, doctors can diagnose ice pick headaches or PSH under the following conditions:

  • The person’s head pain occurs randomly as one jolt or several jolts of pain.
  • The person’s pain only lasts for a few seconds.
  • The pain occurs irregularly.
  • The person has no cranial autonomic symptoms, such as swollen or drooping eyelids, facial sweating, or nasal congestion.
  • The doctor cannot give a better diagnosis for the symptoms.

There is no specific diagnostic test for ice pick headaches. Instead, the doctor will rely on the person’s description of their symptoms.

Similar headache disorders

To make a diagnosis, a doctor may need to rule out a few conditions with similar symptoms. These conditions include the following.

Paroxysmal hemicranias

This is a rare form of headache that tends to appear in adulthood. People experience symptoms, such as severe throbbing and pain, that usually only affect one side of the face. This pain is typically around or behind the eye but occasionally at the back of the neck.

Episodes can occur five to 40 times per day and last for 2–30 minutes. Paroxysmal hemicranias occur more often in women than in men.

Trigeminal neuralgia

This is a chronic pain condition that affects the trigeminal, or fifth, cranial nerve, which is one of the most widely distributed nerves in the head.

Symptoms include infrequent, sudden burning or shock-like facial pain that can last from a few seconds to 2 minutes. The episodes can occur in quick succession for up to 2 hours.

Learn more about trigeminal neuralgia here.

Occipital neuralgia

This rare headache disorder involves the occipital nerves. These two pairs of nerves start near the second and third bones at the top of the spine.

People generally experience pain that starts at the base of the skull, close to the nape of the neck. The pain can then spread to the area behind the eyes and to the back, front, and side of the head.

Symptoms may include continuous aching, burning, throbbing, and intermittent shocking or shooting pain. Some people even describe the pain as similar to that of a migraine headache or a cluster headache.

Learn more about occipital neuralgia here.

Treating an ice pick headache can be difficult. Since the pain is so brief, medications such as pain relievers do not often help. These headaches can occur once or several times per day, at regular intervals, but they never last long.

However, people who experience many painful episodes may want to try some of the available treatment options.

Indomethacin is a nonsteroidal anti-inflammatory drug that can be successful in treating ice pick headaches. Other drug options include gabapentin, cyclooxygenase-2 inhibitors, and melatonin.

Melatonin is available to purchase online here.

For the most part, people can function normally with ice pick headaches.

However, a person should contact a doctor if their symptoms worsen suddenly, increase in frequency, or begin to interrupt their daily activities, such as working or sleeping.

The doctor can review the person’s medical history and come up with an appropriate treatment plan.