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Primary stabbing headache

F Michael Cutrer, MD
Section Editor
Jerry W Swanson, MD, MHPE
Deputy Editor
John F Dashe, MD, PhD


Stabbing headache is one of several relatively uncommon headache syndromes that may occur either as a primary headache or as a headache secondary to potentially malignant processes. Careful evaluation for underlying causes is important for these uncommon types of headache.

This topic will review primary stabbing headache. Other types of uncommon primary headache disorders are discussed separately. (See "Primary cough headache" and "Exertional headache" and "Primary headache associated with sexual activity" and "Hypnic headache" and "Approach to the patient with thunderclap headache" and "Nummular headache".)


In the past, primary (or idiopathic) stabbing headache has been known by several terms, including ice-pick headache, ophthalmodynia periodica, and jabs and jolts syndrome.


Primary stabbing headache is characterized by transient, sharp, jabbing pains [1]. The pains occur anywhere in the head, often in extratrigeminal regions [2], and frequently cause the patient to wince. They appear suddenly either as single stabs or in volleys of mild to intense stabbing pain [1]. They are not associated with cranial autonomic symptoms [3]. Primary stabbing headache has been described in both children and adults [1,4].

The individual stabs typically last for a few seconds and occur at irregular intervals ranging from rare attacks to more than one attack each day [5]. One study of 23 children reported that the stabs lasted 1 to 15 minutes [6], and there is another report of "ice-pick status," with prolonged attacks lasting up to one week [7]. A larger study of 65 subjects identified distinct clinical patterns of primary stabbing headache, with a monophasic pattern characterized by the daily occurrence of a series of stabs over a median duration of 13 days, an intermittent pattern with a few attacks of clustered or sporadic stabs over a median duration of two years, and a chronic daily pattern characterized by longer lasting stabs of lower intensity occurring daily for a median duration of nine months [8].

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Literature review current through: Nov 2017. | This topic last updated: May 16, 2017.
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