An ice pick headache causes brief jolts of stabbing pain. It most commonly affects the front and sides of the head. It can begin suddenly or gradually and last from a few moments to several days.

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 have some understanding of the causes of ice pick headaches, but there are still some unknowns. Doctors can sometimes identify the specific cause of an individual’s ice pick headache, but sometimes the cause is not clear. The cause may vary depending on each individual.

Ice pick headaches are more common in people who also have a history of migraine.

When there is no identifiable cause of a person’s ice pick headache, doctors may refer to it as “idiopathic”, which means spontaneous or without a known cause. In other cases, there may be specific triggers that occur before a person experiences an ice pick headache.

Risk factors and triggers

Older 2014 research suggests that certain lifestyle factors may trigger ice pick headaches, including:

Underlying health conditions

Although doctors may refer to ice pick headaches in general as PSH, the condition can develop as a result of certain health conditions.

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

The pain associated with ice pick headaches tends to last for a few minutes or less. Research suggests that it often occurs in the frontal or temporal area, which means a person may feel the pain in their forehead or temples.

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, smells and sound. Many people also experience nausea and vomiting.

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

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

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.

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 begin during 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

Trigeminal neuralgia 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 — but they can be frequent or constant — sudden burning or shock-like facial pain that can last from a few seconds to 2 minutes. These episodes can occur multiple times a day.

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 episode or a cluster headache.

Learn more about occipital neuralgia.

Treating an ice pick headache can be difficult. Since the pain is so brief, it usually resolves before a person has time to take a pain reliever. These headaches may 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.

Ice pick headaches cause brief jolts of stabbing pain that often affect the front and sides of a person’s head.

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.

A doctor can review the person’s medical history and make an appropriate treatment plan.