Neurological Diseases: Ice Pick Headaches

Introduction

Ice pick headaches are one of the most intense or most severe headaches a person can experience, and idiopathic stabbing headache or jabs and jolts headache are some other names for the same condition.

Luckily they come and go very fast (less than a second or just few seconds). But if you experience a cluster of episodes (several attacks within a brief period) then it could be quite disabling and torturesome to the sufferer. When that happens patients frequently land up in the ER (emergency room). Fortunately many patients do not experience such clusters.

The name is appropriately given after the sharp tool used to chip or break the ice.

Classification

It is lumped under the broad category of primary headache syndromes that includes conditions like migraine, tension and cluster headache etc. The term primary or idiopathic is generally used in medicine when the cause of a disease condition is unknown. When the cause is known it is called as secondary. For example headache induced by a tumor is a secondary headache. Since this headache is not expected to be associated with any known pathologies like tumors, high blood pressure, infections etc it is called as primary headache syndrome or idiopathic headache syndrome.

How does patient present?

This headache affects women more than men. Age of onset around 40 years.

Sudden sharp stabbing or jabbing type pain in and around the eyes lasting less than a second or only for few seconds is characteristic. Areas other than eye region may be involved too. They can occur in clusters. These Patients can experience migraine type headache too and sometimes both can co exist in the same patient.

Diagnosis

Most of the times diagnosis can be accomplished just based on clinical criteria. A CT or MRI of the brain may be needed if we are suspecting any secondary causes producing this type of headache.

Treatment

During one or just few acute attacks thee is nothing to treat because by the time you take the medicine and it starts acting the headache is gone. But during clustering of episodes some pain killer is necessary.

NSAID (non steroidal anti-inflammatory drugs) like indomethacin, ketorolac injection can be tried. Some times opioid drugs may be necessary.

If patient experiences frequent episodes then a preventive agent may be necessary. There is no drug specifically meant for prevention of this headache not there is any drug significantly effective in preventing this type of headache. Medications like propranolol, gabapentin, topiramate, verapamil, sodium valproate can be tried with varying results.

A neurologist is commonly involved in the care of Ice pick headaches.

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