Ophthalmodynia periodica, also known as ice pick headache, is a sudden onset headache with severe head pain on front or sides of the head, which 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? Sharp pain in your head is often caused by dysfunction in the cranial nerves. Abnormal cerebrospinal fluid levels may also cause sharp headache pain.

Ice pick headaches are not well understood, but experts think they come from brief irregularities in your brain’s mechanism for processing pain.

Let’s get into the symptoms, secondary causes, and treatments for ice pick headache (ophthalmodynia periodica). Below, we also examine the differences between ice pick headache and other common headaches.

What is ophthalmodynia periodica?

Ophthalmodynia periodica (also known as an ice pick headache) is a short, severe headache with sudden onset.

What does an ice pick headache feel like? Ice pick headache causes sudden, sharp, stabbing pain around the eyes and sides of the head. It feels like an ice pick going in and out of the eye. The sudden stabbing pain in the head goes away quickly.

How long should ice pick headaches last? Ice pick headaches usually last less than one minute — perhaps only a split second. However, the short-lived pain can be excruciating. Ice pick headache attacks can occur multiple times in a day, while you are awake or sleeping.

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.

First identified in 1964 by Dr. Richard Lansche, our understanding of ophthalmodynia periodica has come a long way, but it’s still incomplete.

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.

Other Names For Ophthalmodynia Periodica

Ophthalmodynia periodica is 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.”

Is it a primary or secondary headache disorder?

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

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

Symptoms of Ice Pick Headache

How does an ice pick headache feel? An ice pick headache can feel like short, sharp strikes to your head with an ice pick. The sharp pain often occurs around the eyes.

What are the symptoms of an ice pick headache? Common symptoms of ice pick headache (ophthalmodynia periodica) include:

  • Sudden onset of head pain with no warning
  • Severe stabbing pain in head or around eyes
  • Sharp head pain on top, front, or sides of head
  • Duration between 3 and 120 seconds (usually closer to 3 seconds)
  • High frequency over the course of a day
  • Nausea
  • Dizziness

Diagnosis of Ophthalmodynia Periodica

How is ophthalmodynia periodica diagnosed? A doctor should use the International Headache Society (IHS) diagnostic criteria to diagnose ophthalmodynia periodica.

Diagnostic criteria for ice pick headaches are as follows:

  • Spontaneous head pain, as a single stab or series of stabs
  • Each stab lasts up to a few seconds
  • Stabs recur irregularly, perhaps once daily to many stabs per day
  • No cranial autonomic symptoms (which would indicate a different headache: SUNA)
  • Not better explained by other types of headaches, such as occipital neuralgia or paroxysmal hemicrania

While many headaches can produce similar pain, each type of headache features a unique sensation and source. Two headaches commonly confused with ice pick headache are:

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 is most often warranted when stabbing pains recur for multiple days. In that case, seek medical advice, and a doctor may prescribe pharmaceutical drugs to relieve the pain. The primary pharmaceutical therapy for ice pick headaches is indomethacin.

Causes & Risk Factors

What causes ophthalmodynia periodica? What causes ice pick headaches (ophthalmodynia periodica) is not well understood. However, some experts believe the primary cause of ice pick headaches is short-term disruptions in your brain’s pain-controlling mechanisms.

There are several known secondary causes of ice pick headaches. From a demographic perspective, women are more likely to get ice pick headaches than men. The average age of a patient with ice pick headache is 28.

What causes ophthalmodynia periodica? According to various scientific studies, ophthalmodynia periodica (ice pick headaches) may be caused by:

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

Can ice pick headaches be aneurysm? In exceedingly rare cases, the sharp pain associated with ice pick headaches could actually be a brain bleed, AKA an aneurysm. Remember, this is extremely uncommon.

Ice Pick Headache Treatments

Ice pick headaches do not usually require treatment and almost always go away after just a few days. However, you should seek treatment for your headache pain if it persists.

How do I avoid ice pick headaches? Based on the causes of stabbing headache pain, here are 4 ways to naturally avoid an ice pick headache:

  • Avoid bright lights, and go to a dark room.
  • Get high-quality sleep at regular intervals.
  • Eat cold foods slowly, or not at all.
  • Avoid or relieve stress whenever possible.

What is the treatment for ophthalmodynia periodica? In the rare case that your ophthalmodynia periodica (ice pick headache) lasts longer than a couple days, there are pharmaceuticals that doctors may prescribe to treat your sharp headache pain:

  • Indomethacin
  • Gabapentin
  • Melatonin
  • Botulinum neurotoxin type-A (botox)
  • Cyclooxygenase-2 (COX-2) inhibitors
  • 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. Indomethacin helps ice pick headache pain go away.

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 more appropriate for pediatric patients. Melatonin may help reduce the frequency of migraines.

Potential side effects of melatonin include:

  • Drowsiness
  • Nausea
  • Headache

Similar Conditions

Ophthalmodynia periodica is similar to multiple other headache types, to the point where it can be confused with migraines or cluster headaches.

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 cause a shorter, sharper pain.

What is the difference between ophthalmodynia periodica and cluster headaches? Cluster headaches and ice pick headaches both occur 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.

What is the difference between ice pick headaches and thunderclap headaches? Thunderclap headaches are sudden and severe, like ice pick headaches. Unlike ice pick headache, though, thunderclap headache typically causes more severe pain and is the result of a severe underlying condition.

Can dehydration cause ice pick headaches? Dehydration headache is a different health condition from an ice pick headache. Dehydration headaches are caused by not drinking enough water. They usually last longer but don’t hurt as much as ice pick headaches.

Long-Term Outlook

Ophthalmodynia periodica (ice pick headache) is a somewhat common phenomenon, especially in migraine sufferers. 2%-35% of the population is estimated to experience ice pick headaches. They can be scary, but now you know what to expect and what to do about it.

Are ice pick headaches something to worry about? No, ice pick headaches are not usually something to worry about. Ice pick headaches don’t typically 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 and neck adjustments.

Make an appointment with us today!

Dr. Ty Carzoli
Dr. Ty Carzoli