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Ophthalmodynia Periodica (Ice Pick Headache): Symptoms & Treatment

Ophthalmodynia periodica, also known as ice pick headache, is a type of sudden onset headache with severe head pain that affects millions of people every year.

Ice pick headaches can be confused with other headaches, so it is important to learn the differences. Although 40% of ice pick headaches patients also suffer from migraines, they are not the same condition.

What causes sharp pains in your head? Sharp headache pain is usually caused by dysfunction in the cranial nerves. Headache pain may also be caused by abnormal cerebrospinal fluid levels.

Ice pick headache pain is not well understood, but experts think it comes from brief irregularities in your brain’s mechanism of processing pain.

Read below to learn about the symptoms, secondary causes, and treatments for ice pick headache (ophthalmodynia periodica). We also examine the differences between ice pick headache and other common headaches.

What is ophthalmodynia periodica?

First identified in 1964, ophthalmodynia periodica (also known as an ice pick headache) is a severe headache with sudden onset. People often describe ophthalmodynia periodica as multiple stabs of pain, like from an ice pick.

Ophthalmodynia periodica usually lasts less than one minute — perhaps only a split second. However, the short-lived ice-pick pain can be excruciating.

Ophthalmodynia periodica headache attacks can occur multiple times in a day, while you are awake or sleeping.

What is ophthalmodynia periodica also known as?

Most modern scientific journals refer to ophthalmodynia periodica as “primary stabbing headaches”, while most consumer-friendly websites use the term “ice pick headaches”.

Ice pick headaches can either be a secondary or primary headache disorder:

  1. Secondary ice pick headaches occur as a symptom of an underlying cause, such as shingles or Bell’s palsy.
  2. Primary ice pick headaches occur not as a symptom of some other underlying condition, but as their own isolated condition.

Are ice pick headaches normal? Between 2% and 35% of the population experiences ice pick headaches at some point in their lifetime.

Symptoms of Ice Pick Headache

Common symptoms of ophthalmodynia periodica (ice pick headache) include:

In some individuals, ice pick headaches can lead to nausea or dizziness.

Diagnosis of Ophthalmodynia Periodica

A doctor will use the International Headache Society (IHS) diagnostic criteria to diagnose ophthalmodynia periodica.

Diagnostic criteria for ice pick headaches are as follows:

  1. Spontaneous head pain, as a single stab or series of stabs
  2. Each stab lasts up to a few seconds
  3. Stabs recur irregularly, perhaps once daily to many stabs per day
  4. No cranial autonomic symptoms (which would indicate a different headache: SUNA)
  5. Not better explained by another ICHD-3 diagnosis (ICHD-3 is the International Classification of Headache Disorders, 3rd edition)

Two headaches commonly confused with ice pick headache are “trigeminal neuralgia” and “short-lasting unilateral neuralgiform headache with conjunctival injection and tearing” (abbreviated as SUNCT).

Doctors may use imaging to diagnose potential secondary causes of ice pick headaches, in which ophthalmodynia periodica could be a symptom.

It is rare for a doctor to have to diagnose ice pick headache, as these headaches seldom recur more than a day or two after onset.

A diagnosis of ice pick headache occurs most often when this stabbing pain recurs for multiple days. In that case, a doctor will likely prescribe pharmaceutical drugs to relieve the pain. The main pharmaceutical therapy for ice pick headaches is indomethacin.

Causes, Triggers, & Risk Factors

What causes ophthalmodynia periodica? The cause of ice pick headaches has not been discovered. However, many experts believe ice pick headaches are caused by short-term disruptions in your brain’s pain-controlling mechanisms.

There are several known secondary causes of ice pick headaches — as in, medical conditions where ice pick headache is a symptom.

From a demographic perspective, women are more likely to get ice pick headaches than men. 28 years old is the average age of an ice pick headache patient

Other ice pick headache triggers and risk factors, according to scientific research, include:

Ice Pick Headache Treatments

Ice pick headaches do not usually require treatment and almost always go away after just a few days.

Based on the reported causes of ice pick headaches, here are 4 tips on how to naturally get rid of your ice pick headache:

  1. Avoid bright lights; go to a dark room
  2. Regular, high-quality sleep
  3. Eat cold food slowly, or not at all
  4. Stress relief

In the rare case that your ice pick headaches last longer than a couple days, there are pharmaceuticals doctors may prescribe, like:

Indomethacin is a non-steroidal anti-inflammatory drug (NSAID) that treats ice pick headaches about 65% of the time — the best of any studied drug.

Side effects of indomethacin:

Gabapentin is another common drug used to treat ice pick headaches. Gabapentin is often prescribed as a second option after indomethacin does not solve the ice pick headache.

Side effects of gabapentin:

Melatonin may be a more suitable treatment option for children with ice pick headaches, due to the limited side effects.

Possible side effects of melatonin include:

Similar Conditions & Complications

Ophthalmodynia periodica is not the same as other headache types. Let’s look at the differences.

How are ice pick headaches different from migraines? Migraine headaches are painful headaches that may cause tingling, nausea, and visual symptoms (called aura). Ice pick headaches typically last much shorter than migraines and cause a different type of pain.

How are ice pick headaches different from cluster headaches? Cluster headaches and ice pick headaches both occur in a series of headaches with sudden onset. But cluster headaches come with these other symptoms:

How are ice pick headaches different from tension headaches? Tension headaches are the most common type of headache. Unlike ice pick headaches, tension headaches lead to moderate pain around your entire head, instead of short severe pain in smaller areas of your head.

Can dehydration cause ice pick headaches? Dehydration headaches are different from ice pick headaches. Dehydration headaches are caused by dehydration, where ice pick headaches are not. They usually last longer, but do not hurt as much and cause more generalized pain.

Looking to the Future

Ophthalmodynia periodica (ice pick headache) is a somewhat common phenomenon, especially in migraine sufferers. Sudden onset severe pain that lasts for a few seconds can be scary, but now you know what it is and what to expect.

Are ice pick headaches something to worry about? No, ice pick headaches are not something to worry about. Ice pick headaches usually do not require medical treatment and are not generally a sign of a severe underlying condition.

Call a healthcare professional right away if your ice pick headaches are affecting your daily life, or if your ice pick headaches have recurred over more than a couple days.

If you are suffering from frequent headaches, consider upper cervical chiropractic care. At Denver Upper Cervical Chiropractic, we use science-based techniques to gently manipulate the spine. Most headache pain can be relieved with spinal adjustments.

Click here to make an appointment with us!

Sources

  1. Chua, A. L., & Nahas, S. (2016). Ice pick headache. Curr pain headache reports, 20(5), 30. Abstract: https://pubmed.ncbi.nlm.nih.gov/27038969/
  2. Olesen, J., et al. (2018). Headache Classification Committee of the International Headache Society (IHS) the international classification of headache disorders, 3rd edition. Cephalalgia, 38(1), 1-211. Full text: https://journals.sagepub.com/doi/10.1177/0333102417738202
  3. Haytoglu, Z., & Herguner, M. O. (2019). Cranial Autonomic symptoms, neck pain: Challenges in pediatric migraine. Annals of Indian Academy of Neurology, 22(3), 282. Full text: http://www.annalsofian.org/article.asp?issn=0972-2327;year=2019;volume=22;issue=3;spage=282;epage=285;aulast=Haytoglu
  4. Caballero, P. E. J., Cuenca, J. C. P., & Naranjo, I. C. (2011). Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) secondary to epidermoid cyst in the right cerebellopontine angle successfully treated with surgery. The journal of headache and pain, 12(3), 385-387. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3094668/
  5. Ozturk, S., & Yetkin, E. (2017). Premature Ventricular Complex Causing Ice-Pick Headache. Case Reports in Cardiology, 2017. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5359434/
  6. Lee, M., Chu, M. K., Lee, J., Yoo, J., & Song, H. K. (2016). Field testing primary stabbing headache criteria according to the 3rd beta edition of International classification of headache disorders: a clinic-based study. The Journal of Headache and Pain, 17(1), 21. Full text: https://link.springer.com/article/10.1186/s10194-016-0615-z
  7. Ergün, U., Özer, G., Sekercan, S., Artan, E., Kudiaki, C., Üçler, S., … & Inan, L. (2009). Headaches in the different phases of relapsing-remitting multiple sclerosis: a tendency for stabbing headaches during relapses. The neurologist, 15(4), 212-216. Abstract: https://pubmed.ncbi.nlm.nih.gov/19590381/
  8. May, A. (2018). Hints on diagnosing and treating headache. Deutsches Ärzteblatt International, 115(17), 299. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5974268/
  9. Ferrante, E., Rossi, P., Tassorelli, C., Lisotto, C., & Nappi, G. (2010). Focus on therapy of primary stabbing headache. The Journal of Headache and Pain, 11(2), 157-160. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3452291/
  10. Franca Jr, M. C., Costa, A. L. C., & Maciel Jr, J. A. (2004). Gabapentin-responsive idiopathic stabbing headache. Cephalalgia, 24(11), 993-996. Abstract: https://pubmed.ncbi.nlm.nih.gov/15482364/
  11. Bermúdez Salazar, M., Rojas Cerón, C. A., & Arana Muñoz, R. S. (2018). Prophylaxis with melatonin for primary stabbing headache in pediatrics: a case report. Colombia Médica, 49(3), 244-248. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6220483/
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