Walsh & Hoyt: Other Short-Lasting Primary Headaches

Primary stabbing headache is defined by the IHS as pain occurring as a single stab or a series of stabs confined to the head and exclusively or predominately felt in the distribution of the trigeminal nerve (orbit, temple, parietal area). The stabs may last for up to a few seconds and recur with irregular frequency from one to many per day. The stabs may remain localized, or may migrate. The syndrome has carried other names over time, including ice-pick headache, idiopathic jabs and jolts, and ophthalmodynia periodica. The duration of the pain ranges from 15 seconds, more frequently between 12 seconds. The attacks are usually unprovoked. There is tremendous variability in the temporal pattern of the attacks. Some patients may experience a single jab, while others may experience volleys of jabs as often as 50 times per day. Autonomic symptoms are conspicuously absent. Visual symptoms are generally absent, although there is one report of transient monocular visual loss associated with primary stabbing headache. Primary stabbing headache is often associated with other primary headache syndromes, such as migraine. According to some studies, idiopathic stabbing pain may occur in 3040% of migraineurs. Peres identified stabbing headache in 41% of patients with hemicrania continua. The absence of autonomic features, as well as the short duration, distinguishes this headache from cluster and CPH. Trigeminal neuralgia may present in a similar fashion, but uncommonly involves V1. Trigeminal neuralgia attacks are usually provoked, and display a consistent response to carbamazepine, features lacking in primary stabbing headache.