What is an Ice Pick Headache? 

Ice pick headaches, sometimes called stabbing headaches or ophthalmodynia periodica, are extremely intense but brief headaches that feel like you are being stabbed with an ice pick. The stabbing pain typically only lasts a few seconds, and the entire attack can last up to one minute. The pain is excruciating, and attacks can happen once to several times a day.  

There are two different types of ice pick headaches: 

• Primary stabbing headache where the ice pick headache is the problem. An underlying problem does not cause it. 
• Secondary stabbing headache, meaning there is an underlying or secondary cause of the ice pick headache that can be treated to provide relief or lower the frequency of their occurrence.  

Symptoms of primary stabbing headaches can be similar to migraines. The intensity of the stabbing pain the headache causes can cause nausea, vomiting, photophobia (sensitivity to light) or phonophobia (sensitivity to sound).  

What causes primary stabbing headaches is still a mystery, but we do know that the triggers for this type of headache are similar to that of migraine headaches and can include: 

• Changes in sleep habits, interrupted sleep, or not sleeping enough 
• Skipping meals 
• Specific foods (for example, lunch meats which can contain nitrates, a compound well-known for causing migraines) 
• Stress 

Secondary stabbing headaches can be the result of another headache disorder mimicking the symptoms of an ice pick headache. These disorders include: 

• SUNCT or Short-lasting, unilateral, neuralgiform headaches and conjunctival injection (redness on the white part of the eye) and tearing 
• Herpetic neuralgia caused by a recent bought of shingles or chicken pox 
• SUNA or Short-lasting unilateral neuralgiform headaches and cranial autonomic symptoms  
• Occipital neuralgia 
• Trigeminal neuralgia 
• A nummular headache 

It is necessary to rule out these headache disorders prior to diagnosing primary stabbing headache to ensure proper diagnosis. 

Treating ice pick headaches is difficult because the attacks are so brief, meaning the attack is over before the sufferer can take medication. But in cases where the headaches occur more than a few times a day, treatment may be necessary to decrease their frequency. For these people, medications such as indomethacin or melatonin can help prevent future occurrences when ice pick headaches occur regularly.