Ice Pick Headache

Ice pick headache is a type of headache that is termed a primary headache. In other words, there is no underlying medical condition contributing to the pain itself. The pain is a sharp stabbing type of pain usually localized around the temples. It may also occur along the side of the face. It usually lasts a few seconds.

"I have these very sudden sharp pains in my head on a daily basis. It feels as if I'm being stabbed in the head" is the usual complaint I hear when assessing a patient for ice pick headaches. With further discussion I usually find out that the person has a history of migraines, but they are getting better and not as severe as they used to be.

If you want to get technical the criteria for this are:

  • Head pain occurring as either a single or series of jabs.
  • Predominately or exclusively around the orbit, temple and side of the face.
  • Stabs last for only a few seconds and occur irregularly during the day.
  • No other symptoms.

If you are getting sharp stabbing pains on top of head or at the base of the skull, this is probably not ice pick. Most probably this is related to cervicogenic headache and many times when treated with an antispasmotic the pains are relieved completely.

Ice pick headaches are many times seen in patients who have migraine headache symptoms although they occur outside of the migraine headache phase. I have even had patients who have gotten their migraines totally under control, yet continue to have ice pick headaches regularly.

Occasionally, this type of pain is also seen in post-traumatic headache syndrome.

Tests and Treatment for Ice Pick Headaches

As always, if this is a new onset of headache for you, please see your doctor as you may need to have a CT or MRI of the brain.

A physical exam should also address issues of neck pain as this may be contributing to the problem.

Treatment of this is usually Indocin (indomethacin), which is an anti-inflammatory. This particular medication is stronger than motrin but not as strong as a steroid. It does have the potential to cause rather severe reflux, so I usually put a patient on a medication to prevent this (Pepcid or Prilosec) while they are taking indomethacin. If you are placed on this and begin to have severe stomach pain, contact your provider right away. Rarely, this can cause a peptic ulcer.

Long term use of indomethacin increases the risk of ulcers and GI bleeds, but again the above listed medication may prevent this. Rarely visual problems can result. If you are diabetic you might not be able to take this medication. Many times, diabetics have decreased kidney function, and unfortunately, anti-inflammatory drugs can affect the kidneys.

Having said all this, many times patients tell me that the headaches just went away on their own, without any need for Indocin.

Like other headache treatments, usually a few months of treatment sees a reduction in pain and the medication can be withdrawn.

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