Ice Pick Headache Signs and Symptoms

People who suffer from migraine symptoms or cluster headaches are more likely to experience what's known as an ice pick headache—a sudden, stabbing pain that hits with no warning.

Ice pick headache

You'll know an icepick headache when one hits you.

Photo: Dreamstime

An ice pick headache—the type that causes a stabbing pain and usually centers in the temple area or around the eyes—is very rare. For most people, thankfully, it’s brief. In 80 percent of ice pick headache sufferers, symptoms last from one to 10 seconds. For those prone to ice pick headaches, however, they can occur several times a day.

Another symptom you may notice with an ice pick headache is that you develop swollen, watery eyes and drooping eyelids, with pupil constriction in one or both eyes. You also may notice accompanying nasal congestion.

Because ice pick headaches strike so fast and usually resolve rapidly, treating them isn’t easy. They often will have dissipated before you can take any painkilling medication.

The cause of ice pick headaches (sometimes written as “icepick” headaches) is unknown. Some research suggests, however, that they may be related to head injuries.

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Diagnosing Ice Pick Headaches

When it comes to diagnosing your ice pick headaches, your doctor will be guided by the information provided in the International Classification of Headache Disorders (ICHD). The ICHD is also used to diagnose other types of headaches, including migraines, tension headaches, and cluster headaches (you can access it yourself at www.ichd-3.org).

The ICHD classifies headaches based on clinical and laboratory observations. For ice pick headaches, it notes other terms that have been used to describe this type of headache—for example, ice-pick pains, jabs, and jolts, needle-in-the-eye syndrome, ophthalmodynia periodica, and sharp but short-lived head pain.

FYI

ICE PICK HEADACHE BRIEFS

  • Ice pick headaches are not thought to involve the trigeminal nerve, which is the largest cranial nerve and transmits sensations from the face to the brain. By contrast, the trigeminal nerve does play a role in migraine symptoms, meaning that if you suffer from migraines, you’ll feel pain in your face.
  • Ice pick headaches move from one area of the head to another in about 70 percent of cases. In about one-third of all patients, though, these headaches occur in one area of the head.
  • If you suffer from ice pick headaches in the exact same spot and they happen often, your doctor may refer you for a diagnostic test (such as magnetic resonance imaging) to make sure there isn’t an underlying structural reason for your headaches.

The ICHD describes ice pick headaches as “transient and localized stabs of pain in the head,” and notes also that these headaches occur spontaneously, without any evidence of disease in the underlying structures of the face, or of the cranial nerves.”

The diagnostic criteria it provides for your doctor are as follows:

A. Head pain occurring spontaneously as a single stab or series of stabs, and fulfilling criteria B-D.
B. Stabs that each last for up to a few seconds.
C. Stabs that recur with irregular frequency, from one to many per day.
D. No cranial autonomic symptoms.
E. Symptoms that aren’t better accounted for by another ICHD-3 diagnosis.

Treating and Preventing Ice Pick Headaches

If you’re prone to ice pick headaches, there are a number of steps you can take to try to prevent them.

Since they tend to occur alongside migraines and cluster headaches, they may respond to medications that treat those types of headaches.

One option for ice pick headache treatment is indomethacin (Indocin), a nonsteroidal anti-inflammatory drug (NSAID) similar to ibuprofen (Advil, Motrin). Indomethicin must be taken sparingly, however—particularly by people with heart disease, since long-term use is associated with a greater risk for heart attack and stroke.

Since it is an NSAID, other side effects also are possible—for example, gastrointestinal bleeding. It also has been linked to eye problems, so if you take it you should have regular (at least annual) eye exams.

There also is evidence that melatonin supplements (which can be used to help prevent jetlag) may be effective for easing an ice pick headache. And boost your intake of foods that naturally contain melatonin—these include pineapples, bananas, oranges, sweet corn, and tomatoes.

Meditation and other stress-relief options also may reduce the frequency of ice pick headaches, according to research.

FYI

WHICH HEADACHE?

Headaches can bring with them various symptoms and for different lengths of times. See these related University Health News articles:


Originally published in May 2016 and updated.

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