Ice Pick Headaches, Causes, Symptoms, Treatment

Ice Pick Headaches
This headache is often known as “jolts and Jabs” headache. Patients experience a sudden brief sharp pain lasting only for a few seconds around the eye or temple area or over the face. It is a severe sharp pain lasting only for a few seconds. These episodes might occur a few times to hundreds of times a day. patient feels like being hit with an ice pick due to the momentary intensity of the pain.

Causes
These headaches are more common in people who have underlying tendency to have migraine or cluster headaches. Exact etiology is not clear however, It is not uncommon to see this type of headache in people who do not have any previous history of any types of headaches. Occasionally, it can occur at the site of previous injury to the scalp in which case it could be due to the irritation or damage to the sensory nerve fibers supplying the scalp but then one would expect this pain to occur only at one spot rather than shifting back and forth.

The headache tends to be more frequent when patient is under stress or exposed to intense lights or loud noise. These headaches are benign in nature and are not indicative of any underlying serious pathology involving the brain like a brain tumor or intracranial aneurysm, so the patient should be reassured.

Symptoms
Sudden onset of sharp jabbing pain lasting only for a few seconds around the eye, temple or any other area of the head.
Occurrence of the headache at one location or it might shift back and forth affecting different parts of the scalp

Headache tend to occur more often under stress or on exposure to bright lights and loud noise.

If the pain occurs over the face, a distinction from Trigeminal
Neuralgia needs to be made for appropriate treatment, similarly if the pain attacks are confined to the posterior part of the head only then it needs to be distinguished from Occipital 
Neuralgia  which is due to the entrapment of the greater occipital nerve posteriorly over the occiput. 

Differential Diagnoses

Trigeminal Neuralgia
Trigeminal neuralgia is due to compression of the trigeminal nerve intracranially by tiny blood vessels crossing the nerve and thus irritating the nerve. Pain is confined most commonly to the ipsilateral forehead or maxillary area. Patient feels very sharp shooting pains which come and go and can be triggered by touching or tapping the skin over the affected areas of the face, similarly pain can be induced by swallowing or chewing movements. Such patients experience onset of the pain on washing the face, putting the makeup on or  shaving. Some patients who experience frequent episodes become afraid of eating the food or washing or touching the face or brushing teeth.

Occipital Neuralgia
In this case, greater occipital nerve gets entrapped over the posterior part of the head where it pierces the skin. Patient complains about having significant degree of pain and discomfort over the occipital area ipsilaterally, the pain tends to become intensified on touching or percussing the area. On percussion, in addition to pain patient also experiences tingling sensation around the area.

Treatment
If ice pick headache is infrequent, no treatment is necessary because by the time medication starts working, pain is already gone. Patient need to be reassured that these types of headaches are not indicative of anything serious and the do not need to worry about it.

If these headaches are occurring multiple times a day or on daily basis then use of nonsteroidal anti-inflammatory medications (NSAIDs) is helpful. Most effective drug among NSAIDs is indomethacin, which can be used 25 mg 2-3 times a day however, this drug should not be used for long time because it has serious side effects of causing stomach ulcers, kidney problems, liver problems and low platelet or WBC count. So, after patient has been free of these attacks for a month or so, attempt should be made to taper off the medication. CBC and CMP also needs to be monitored periodically while patient is on this medication.

Some patients get benefit from use of drugs which relax the head muscles which include doxepin, Zanaflex, methocarbamol.

Patients also benefit from learning to relax because stress tends to exacerbate these attacks.

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About the Author

Javaid Iqbal, MD

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