Idiopathic stabbing headache

Clinical manifestations
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By Mario F P Peres MD

Idiopathic stabbing headache was first described in 1964, at which time it was called "ophthalmodynia periodica" (Lansche 1964). Since then, brief, sharp, jabbing pains that occur either as single episodes or in repeated flurries have been designated by various terms including: "icepick-like pains," "sharp short-lived head pains," "needle-in-the-eye syndrome," and "jabs and jolts syndrome" (Raskin and Schwartz 1980; Sjaastad et al 1980; Mathew 1981; Spierings 1990). The International Classification of Headache Disorders, 2nd edition, 2004 uses the term "idiopathic stabbing headaches," classified under item 4 – other primary headaches.

Table 1. Diagnostic Criteria for Idiopathic Stabbing Headache

(A) Head pain occurring as a single stab or a series of stabs fulfilling B to D
(B) Exclusively or predominantly felt in the distribution of the first division of the trigeminal nerve (orbit, temple, parietal area)
(C) Stabs last for up to a few seconds and recur with irregular frequency ranging from 1 to many per day
(D) No accompanying symptoms
(E) Not attributed to another disorder

These pains are usually unilateral, but may be bilateral. They occur mainly around the orbit or the temple and less frequently in the occipital and parietal areas. Attacks usually recur in the same area. If they occur in patients with other types of headache, they are characteristically located on the same side and frequently at the same site of the customary headache.

Great variability exists in the temporal pattern of attacks. Most patients experience only single jabs, although some may have volleys of jabs. Attacks may be experienced as often as 50 times per day.

Accompanying phenomena, such as tearing, eye redness, or nausea, are absent.

A few patients report precipitating triggers for their idiopathic stabbing headaches. These triggers include rapid alterations in posture, physical exertion, bright light, and head motion during migraine attacks (Raskin and Schwartz 1980). In most patients, however, the pain is unprovoked.

Piovesan and colleagues studied idiopathic stabbing headaches in 280 migraine patients (Piovesan et al 2001). Mean duration of the idiopathic stabbing headaches was 1.42 seconds (1 second in 72.4% of patients, 2 seconds in 18.1%, 3 seconds in 6.3%, 4 seconds in 1%, and 5 seconds in 2%). Pain paroxysms were unilateral in 91.4% of patients and bilateral in 8.6% of patients. The pain location was in the temporal region in 60% of patients, occipital in 15%, frontal in 8%, temporal and occipital in 7.4%, parietal in 5.3%, frontal and temporal in 1%, cervical in 1%, and ocular in 1%. A study by Selekler and Budak compared idiopathic stabbing headache and experimentally induced ice cream headache localizations in migraine patients (Selekler and Budak 2004). Ice cream headache was localized in the vertex region in 94%, while it was localized in this region in 45% for idiopathic stabbing headache.

Ammache and colleagues described a 27-year-old man with idiopathic stabbing headaches associated with complete vision loss ipsilateral to the pain (Ammache et al 2000). The patient had a history of migraine with aura. Fusco and colleagues reported 23 adolescent patients. Mean age at onset was 9 years. Headache location was bilateral in 60% of the patients and unilateral in 40%. The pain was orbital or temporal in 60% of patients and multifocal in 40%. In 24% of the children, the interictal awake EEG showed infrequent posterior slow waves (Fusco et al 2003).

In This Article

Clinical manifestations
Clinical vignette
Pathogenesis and pathophysiology
Differential diagnosis
Diagnostic workup
Prognosis and complications
References cited