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

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

What causes sharp pains in your head? Intermittent sharp headache pain is usually caused by dysfunction in the cranial nerves. Abnormal cerebrospinal fluid levels may also cause headache pain.

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 on 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 by Dr. Richard Lansche, 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.

In 2016, the diagnostic criteria for ice pick headache were revised by the 3rd beta edition of International Classification of Headache Disorders (ICHD-3). The ICHD-3 posits that ice pick headaches involve all head areas, not just the ophthalmic branch region of the trigeminal nerve.

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

What is ophthalmodynia periodica also known as? Ophthalmodynia periodica can also be known as:

  • Ice pick headache
  • Primary stabbing headache
  • Needle-in-the-eye syndrome
  • Idiopathic stabbing headache
  • Short-lived head pain syndrome
  • Jabs and jolts syndrome

Most modern scientific journals refer to ophthalmodynia periodica as “primary stabbing headaches,” while most 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? While an ice pick headache feels anything but normal, between 2% and 35% of the population experiences ice pick headaches at some point in their lifetime.

Symptoms of Ice Pick Headache

How does an ice pick headache feel? An ice pick headache feels like short, sharp strikes to your head with an ice pick, according to some sufferers. Common symptoms of ophthalmodynia periodica (ice pick headache) include:

  • Sudden onset of head pain with no warning
  • Severe stabbing pain
  • Head pain on top, front, or sides of head
  • Lasts between 3 and 120 seconds (usually closer to 3 seconds)
  • Can occur dozens of times a day

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

Diagnosis of Ophthalmodynia Periodica

How is ophthalmodynia periodica diagnosed? 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 other types of headaches, such as occipital neuralgia or paroxysmal hemicrania

While many headaches can produce similar pain, each has an individual sensation and source. Two headaches commonly confused with ice pick headache are:

  1. Trigeminal neuralgia
  2. 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 actually 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 primary pharmaceutical therapy for ice pick headaches is indomethacin.

Causes, Triggers, & Risk Factors

What causes ophthalmodynia periodica? The cause of ice pick headaches is not well understood. 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 — “secondary” meaning medical conditions of which ice pick headache is a symptom.

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

What is the cause of stabbing headache? According to scientific research, other stabbing headache causes, triggers, and risk factors include:

  • Changes in weather
  • Lack of sleep
  • Bright lights
  • Posture changes
  • Emotional stress
  • Eating ice cream or drinking a cold drink 

Ice Pick Headache Treatments

Ice pick headaches do not usually require treatment and almost always go away after just a few days. However, you may want to try and treat your headache pain.

How do you get rid of a stabbing headache? Based on the causes of stabbing headache pain, here are 4 ways to naturally get rid of a primary stabbing headache:

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

Botulinum neurotoxin type-A (botox) may also relieve ice pick headache pain, as well as other headache disorders like nummular headaches or hypnic headaches.

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

  • Indomethacin
  • Gabapentin
  • Melatonin
  • Nifedipine
  • Paracetamol
  • Celecoxib

Indomethacin

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:

  • Nausea, vomiting
  • Dizziness
  • Heartburn
  • Kidney problems
  • Abdominal pain
  • Diarrhea
  • Constipation
  • Headache

Gabapentin

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:

  • Drowsiness
  • Dizziness
  • Fatigue
  • Vision problems
  • Tremors

Melatonin

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:

  • Drowsiness
  • Nausea
  • Headache

Similar Conditions & Complications

Ophthalmodynia periodica is similar to but different from other headache types. Let’s look at similar conditions that are sometimes confused with ophthalmodynia periodica.

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. However, cluster headaches come with these other symptoms:

  • Redness of the eye
  • Drooping eyelid
  • Swelling around the eye
  • Tears in the eye
  • Runny or stuffy nose

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 don’t 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.

Make an appointment with us today!

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