Primary stabbing headache

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By Mario F P Peres MD

Primary stabbing headache is also known as or subsumes idiopathic stabbing headacheIcepick-like pains, Jabs and jolts syndrome, and Ophthalmodynia periodica. -ed.

The author overviews the clinical symptoms, classification, etiology, and treatment of idiopathic stabbing headaches. Indomethacin is the main therapeutic option for this type of headache, but melatonin has been shown to be effective in some cases. Idiopathic stabbing headache can be a primary headache, but it is usually associated with another primary headache disorder.

Key points

  • Primary stabbing headache is usually a benign self-limited primary headache disorder, consisting of sharp stabs of pain predominantly felt in the first division of the trigeminal nerve.
  • Imaging is reasonable to exclude secondary causes.
  • Indomethacin is the first-line treatment for primary stabbing headache.
  • Other therapeutic options include melatonin, gabapentin, and celecoxib.

Primary 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, 3rd edition, uses the term "primary stabbing headache," classified under item 4—other primary headaches.

In This Article

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