Skip to main content

Ice Pick Headache


Ice pick headache, also called idiopathic or primary stabbing headache, is a unique headache type associated with ultra-brief stabs of pain, most commonly in the frontal or temporal area. It occurs predominantly in women and is estimated to affect 2–35 % of the population. Unlike other headache types of short duration, such as short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), ice pick headache is not associated with any cranial autonomic symptoms but has been known to occur with nausea, vomiting, photophobia, and dizziness. It exists in two forms: primary and secondary, with examples of secondary causes being herpes zoster meningoencephalitis, meningiomas, stroke, and multiple sclerosis. Ice pick headache is one of the “indomethacin responsive headaches,” but up to 35 % of patients fail to show significant benefit with that treatment. Other treatment options include gabapentin, cyclooxygenase-2 inhibitors, melatonin, and external hand warming.

This is a preview of subscription content, access via your institution.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.

    Raskin NH, Schwartz RK. Ice pick-like pain. Neurology. 1980;3:203–5.

    Article  Google Scholar 

  2. 2.

    Lansche RK. Ophthalmodynia periodica. Headache. 1964;4:247–9.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Pareja JA, Ruiz J, de Isla C, al-Sabbah H, Espejo J. Idiopathic stabbing headache (jabs and jolts syndrome). Cephalalgia. 1996;16(2):93–6.

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Mathew NT. Indomethacin responsive headache syndromes. Headache. 1981;21(4):147–50.

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Dodick DW. Indomethacin-responsive headache syndromes. Curr Pain Headache Rep. 2004;8(1):19–26.

    Article  PubMed  Google Scholar 

  6. 6.

    Headache Classification Committee if the International Headache Society. The international classification of headache disorders, 2nd edition. Cephalalgia. 2004;21:617–8.

    Google Scholar 

  7. 7.

    Sjaastad O, Pettersen H, Bakketeig LS. The Vågå study of headache epidemiology II. Jabs: clinical manifestations. Acta Neurol Scand. 2002;105(1):25–31.

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Shin JH, Song HK, Lee JH, Kim WK, Chu MK. Paroxysmal stabbing headache in the multiple dermatomes of the head and neck: a variant of primary stabbing headache or occipital neuralgia? Cephalalgia. 2007;27(10):1101–8.

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Fuh JL, Kuo KH, Wang SJ. Primary stabbing headache in a headache clinic. Cephalalgia. 2007;27(9):1005–9.

    Article  PubMed  Google Scholar 

  10. 10.

    Headache Classification Committee of the International Headache Society (HIS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629–808.

    Article  Google Scholar 

  11. 11.

    Rasmussen BK. Epidemiology of headache. Cephalalgia. 1995;15(1):45–68.

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Sjaastad O, Pettersen H, Bakketeig LS. The Vågå study; epidemiology of headache I: the prevalence of ultrashort paroxysms. Cephalalgia. 2001;21(3):207–15.

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Guerrero AL, Herrero S, Peñas ML, Cortijo E, Rojo E, Mulero P, et al. Incidence and influence on referral of primary stabbing headache in an outpatient headache clinic. J Headache Pain. 2011;12(3):311–3.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  14. 14.•

    Hagler S, Ballaban-Gil K, Robbins MS. Primary stabbing headache in adults and pediatrics: a review. Curr Pain Headache Rep. 2014;18(10):450. Most recent review of the topic. Provides thorough overview of both adult and pediatric PSH.

    Article  PubMed  Google Scholar 

  15. 15.

    Pareja JA, Sjaastad O. Primary stabbing headache. Handb Clin Neurol. 2010;97:453–7.

    Article  PubMed  Google Scholar 

  16. 16.

    Myers KA, Smyth KA. Preadolescent indomethacin-responsive headaches without autonomic symptoms. Headache. 2013;53(6):977–80.

    Article  PubMed  Google Scholar 

  17. 17.

    Pedraza MI, Guerrero-Peral ÁL, Herrero-Velázquez S, Mulero P, Barón J, Ruiz M, et al. Primary stabbing headache: clinical characteristics and response to treatment in a series of 67 patients. Rev Neurol. 2012;55(8):469–74.

    PubMed  Google Scholar 

  18. 18.

    Piovesan EJ, Kowacs PA, Lange MC, Pacheco C, Piovesan LR, Werneck LC. Prevalence and semiologic aspects of the idiopathic stabbing headache in a migraine population. Arq Neuropsiquiatr. 2001;59(2A):201–5.

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Sjaastad O, Pettersen H, Bakketeig LS. Long-lasting cephalic jabs (?) The Vågå study of headache epidemiology. Cephalalgia. 2005;25(8):581–92.

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Martins IP, Parreira E, Costa I. Extratrigeminal ice-pick status. Headache. 1995;35(2):107–10.

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Sjaastad O, Pettersen H, Bakketeig LS. Extracephalic jabs/idiopathic stabs. Vågå study of headache epidemiology. Cephalalgia. 2003;23(1):50–4.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Selekler MH, Komsuoglu SS. Extracephalic stabbing pain temporally related to cephalic ones. Headache. 2004;44(7):719–21.

    Article  PubMed  Google Scholar 

  23. 23.

    Liang X, Ying G, Huang Q, Wang J, Li N, Tan G, et al. Characteristics of primary stabbing headache in a tertiary neurological clinic in China. Pain Med. 2014;15(5):871–5.

    Article  PubMed  Google Scholar 

  24. 24.

    Selekler HM, Komşuoğlu SS. The relationship of stabbing headaches with migraine attacks. Agri. 2005;17(1):45–8.

    PubMed  Google Scholar 

  25. 25.

    Wilbrink LA, Weller CM, Cheung C, Haan J, Ferrari MD. Cluster-tic syndrome: a cross-sectional study of cluster headache patients. Headache. 2013;53(8):1334–40.

    Article  PubMed  Google Scholar 

  26. 26.

    Marin LF, Felício AC, Santos WA, Silva PC, Gorinchteyn JC, Marinho IS. Stabbing headache as the initial manifestation of herpetic meningoencephalitis. J Headache Pain. 2010;11(5):445–6.

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Rozen TD. Brief sharp stabs of head pain and giant cell arteritis. Headache. 2010;50(9):1516–9.

    Article  PubMed  Google Scholar 

  28. 28.

    Knash ME, Monteith TS, Raskin NH. A comment on brief sharp stabs of head pain and giant cell arteritis. Headache. 2011;51(6):1010.

    Article  PubMed  Google Scholar 

  29. 29.

    Mascellino AM, Lay CL, Newman LC. Stabbing headache as the presenting manifestation of intracranial meningioma: a report of two patients. Headache. 2001;41(6):599–601.

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    Levy MJ, Matharu MS, Meeran K, Powell M, Goadsby PJ. The clinical characteristics of headache in patients with pituitary tumours. Brain. 2005;128(Pt 8):1921–30.

    CAS  Article  PubMed  Google Scholar 

  31. 31.

    Piovesan EJ, Zukerman E, Kowacs PA, Werneck LC. COX-2 inhibitor for the treatment of idiopathic stabbing headache secondary to cerebrovascular diseases. Cephalalgia. 2002;22(3):197–200.

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Robbins MS. Transient stabbing headache from an acute thalamic hemorrhage. J Headache Pain. 2011;12(3):373–5.

    Article  PubMed  PubMed Central  Google Scholar 

  33. 33.

    Klein M, Woehrl B, Zeller G, Straube A. Stabbing headache as a sign of relapses in multiple sclerosis. Headache. 2013;53(7):1159–61.

    Article  PubMed  Google Scholar 

  34. 34.

    Ergün U, Ozer G, Sekercan S, Artan E, Kudiaki C, Uçler S, et al. Headaches in the different phases of relapsing-remitting multiple sclerosis: a tendency for stabbing headaches during relapses. Neurologist. 2009;15(4):212–6.

    Article  PubMed  Google Scholar 

  35. 35.

    Rampello L, Malaguarnera M, Rampello L, Nicoletti G, Battaglia G. Stabbing headache in patients with autoimmune disorders. Clin Neurol Neurosurg. 2012;114(6):751–3.

    Article  PubMed  Google Scholar 

  36. 36.

    Montella S, Ranieri A, Marchese M, De Simone R. Primary stabbing headache: a new dural sinus stenosis-associated primary headache? Neurol Sci. 2013;34 Suppl 1:S157–9.

    Article  PubMed  Google Scholar 

  37. 37.

    Silberstein SD, Lipton RB, Dodick DW. Wolff’s headache and other head pain. 8th ed. Oxford: Oxford UP; 2008.

    Google Scholar 

  38. 38.

    Harrigan MR, Tuteja S, Neudeck BL. Indomethacin in the management of elevated intracranial pressure: a review. J Neurotrauma. 1997;14(9):637–50.

    CAS  Article  PubMed  Google Scholar 

  39. 39.

    Medina JL, Diamond S. Cluster headache variant. Spectrum of a new headache syndrome. Arch Neurol. 1981;38(11):705–9.

    CAS  Article  PubMed  Google Scholar 

  40. 40.

    Ferrante E, Rossi P, Tassorelli C, Lisotto C, Nappi G. Focus on therapy of primary stabbing headache. J Headache Pain. 2010;11(2):157–60.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  41. 41.

    Williams GW. An update on nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors. Curr Pain Headache Rep. 2005;9(6):377–89.

    Article  PubMed  Google Scholar 

  42. 42.

    O'Connor MB, Murphy E, Phelan MJ, Regan MJ. Primary stabbing headache can be responsive to etoricoxib, a selective COX-2 inhibitor. Eur J Neurol. 2008;15(1):e1.

    Article  PubMed  Google Scholar 

  43. 43.

    França Jr MC, Costa AL, Maciel Jr JA. Gabapentin-responsive idiopathic stabbing headache. Cephalalgia. 2004;24(11):993–6.

    Article  PubMed  Google Scholar 

  44. 44.

    Vioxx pulled from global market. Last accessed January 22, 2016

  45. 45.

    Jacome DE. Exploding head syndrome and idiopathic stabbing headache relieved by nifedipine. Cephalalgia. 2001;21(5):617–8.

    CAS  Article  PubMed  Google Scholar 

  46. 46.

    Rozen TD. Melatonin as treatment for idiopathic stabbing headache. Neurology. 2003;61(6):865–6.

    Article  PubMed  Google Scholar 

  47. 47.

    El-Shenawy SM, Abdel-Salam OM, Baiuomy AR, El-Batran S, Arbid MS. Studies on the anti-inflammatory and anti-nociceptive effects of melatonin in the rat. Pharmacol Res. 2002;46(3):235–43.

    CAS  Article  PubMed  Google Scholar 

  48. 48.

    Piovesan EJ, Teive HG, Kowacs PA, Silva LL, Werneck LC. Botulinum neurotoxin type-A for primary stabbing headache: an open study. Arq Neuropsiquiatr. 2010;68(2):212–5.

    Article  PubMed  Google Scholar 

  49. 49.

    Hofstadter-Duke KL, Allen KD. External hand warming as a novel treatment for ice pick headaches: a controlled case study. Appl Psychophysiol Biofeedback. 2011;36(2):129–33. doi:10.1007/s10484-011-9146-1.

    Article  PubMed  Google Scholar 

  50. 50.

    Hermann C, Blanchard EB. Biofeedback in the treatment of headache and other childhood pain. Appl Psychophysiol Biofeedback. 2002;27(2):143–62.

    Article  PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Abigail L. Chua.

Ethics declarations

Conflict of Interest

Abigail L. Chua and Stephanie Nahas declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Uncommon and/or Unusual Headaches and Syndromes

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Chua, A.L., Nahas, S. Ice Pick Headache. Curr Pain Headache Rep 20, 30 (2016).

Download citation


  • Ice pick headache
  • Primary stabbing headache
  • Idiopathic stabbing headache
  • Jabs and jolts
  • Indomethacin responsive