Stabbing Headache
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Primary stabbing headache is characterized by brief, sharp pains that occur spontaneously in the head. It was first described in 1964. Diagnostically, it involves stabs of pain lasting up to a few seconds that recur irregularly throughout the day, without autonomic symptoms or underlying pathology. Indomethacin is the first line treatment if symptoms require management.
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This document discusses new daily persistent headache (NDPH), a primary headache syndrome characterized by a new onset headache that persists daily for more than 3 months. It reviews the epidemiology and proposed etiologies of NDPH, including persistent central nervous system inflammation and cervical spine issues. The clinical manifestations and diagnostic criteria of NDPH are outlined. Differential diagnoses and evaluation are also discussed. Finally, the document summarizes management approaches for NDPH, including acute and preventative treatment options.
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Stabbing Headache
- 1. Ade Wijaya, MD – December 2019
- 2. Outline: Introduction Epidemiology Diagnostic Criteria Pathophysiology Diagnostic Workups Differential Diagnosis Secondary Stabbing Headache Treatment Summary
- 3. Introduction First described by Lansche in 1964 as “ophthalmodynia periodica” Ice pick pains, jabs and jolts, needle-in-the-eye syndrome, and sharp short-lived head pain. “transient and localized stabs of pain in the head that occur spontaneously in the absence of organic disease of underlying structures or of the cranial nerves.” LanscheRK.Ophthalmodynia Periodica. Headache. 1964;4:247–9. International Classification of Headache Disorders, Third Edition (ICHD-3)
- 4. Epidemiology Prevelence: 0.2 to 35% Female > Male Varied age of onset Murray D, Dilli E. Primary Stabbing Headache. Current neurology and neuroscience reports. 2019 Jul 1;19(7):47.
- 5. Diagnostic Criteria A. Head pain occurring spontaneously as a single stab or series of stabs and fulfilling criteria B and C B. Each stab lasts for up to a few seconds C. Stabs recur with irregular frequency, from one to many per day D. No cranial autonomic symptoms E. Not better accounted for by another ICHD-3 diagnosis International Classification of Headache Disorders, Third Edition (ICHD-3)
- 6. Diagnostic Criteria For Probable Primary Stabbing Headache A. Head pain occurring spontaneously as a single stab or series of stabs B. Two only of the following: 1. each stab lasts for up to a few seconds 2. stabs recur with irregular frequency, from one to many per day 3. no cranial autonomic symptoms C. Not fulfilling ICHD-3 criteria for any other headache disorder D. Not better accounted for by another ICHD-3 diagnosis International Classification of Headache Disorders, Third Edition (ICHD-3)
- 7. Patophysiology Irritation of trigeminal and extratrigeminal nerves Intermittent impairment of central pain processing leading to hyper- excitability of neurons or spontaneous synchronous discharge of neurons Vascular mechanism Segmental disinhibition of central pain processing Murray D, Dilli E. Primary Stabbing Headache. Current neurology and neuroscience reports. 2019 Jul 1;19(7):47.
- 8. Diagnostic Workups Rule out secondary causes Aware of red flags Brain CT/MRI Laboratory; ESR/CRP Murray D, Dilli E. Primary Stabbing Headache. Current neurology and neuroscience reports. 2019 Jul 1;19(7):47. Robbins MS, Evans RW. Primary and secondary stabbing headache. Headache: The Journal of Head and Face Pain. 2015 Apr;55(4):565-70.
- 9. Differential Diagnosis Secondary causes Trigeminal autonomic cephalalgias such as SUNCT, SUNA, paroxysmal hemicrania, and hemicrania continua Primary cough headache, primary headache associated with sexual activity, primary exertional headache, and cold stimulus headache Trigeminal neuralgia Murray D, Dilli E. Primary Stabbing Headache. Current neurology and neuroscience reports. 2019 Jul 1;19(7):47.
- 10. Secondary Stabbing Headache Encephalitis Vasculitis Neoplasm Idiopathic Intracranial Hypertension Dural sinus stenosis Brainstem inflammation or focal demyelination Robbins MS, Evans RW. Primary and secondary stabbing headache. Headache: The Journal of Head and Face Pain. 2015 Apr;55(4):565-70. Murray D, Dilli E. Primary Stabbing Headache. Current neurology and neuroscience reports. 2019 Jul 1;19(7):47.
- 11. Treatment Indomethacin (75 to 250 mg/day in divided doses) Alternative treatments: Selective COX-2 inhibitors, etoricoxib and celecoxib Melatonin Onabotulinumtoxin A (BoNTA) Gabapentin Topiramate Acetazolamide Nifedipine Robbins MS, Evans RW. Primary and secondary stabbing headache. Headache: The Journal of Head and Face Pain. 2015 Apr;55(4):565-70. Murray D, Dilli E. Primary Stabbing Headache. Current neurology and neuroscience reports. 2019 Jul 1;19(7):47.
- 12. Summary Stabbing pain without autonomic symptoms Benign Indomethacin (first line; if treatment needed)