Lately, I have had numerous patients in complaining about short, but painful, stabbing sensations behind the eye. I used to get these quite frequently. Thankfully, I have not had one in some time. I wasn’t sure what these were until I read about them in a doctor’s office headache book. Ice pick headaches are painful, severe headaches that come on suddenly. They’re often described as feeling like a stabbing blow, or a series of stabs, from an ice pick. They give no warning before occurring and can be excruciating and debilitating. They’re also brief, typically lasting no longer than a minute. Ice pick headaches can occur at any time, during sleeping or waking hours. They may also happen multiple times within one day and move from place to place in the head.


Ice pick headaches are categorized by several variable symptoms. These symptoms include: a sudden, stabbing head pain which typically lasts for seconds; a pain which may be categorized as moderately severe to extremely painful; stabs that can occur once or many times in waves over several hours; stabs that can occur up to 50 times per day; stabs that occur without warning; pain that is typically felt on the top, front, or sides of the head; and stabs that may occur in multiple areas of the head, one at a time. Ice pick headaches are sometimes associated with cluster or migraine headaches, but they vary from these types. Their symptoms don’t include any signs such as: facial flushing, eyelid drooping, or tearing.


Migraines are intense, debilitating headaches. They’re longer lasting, sometimes lingering for hours or days. Migraine pain usually occurs only on one side of the head and may be preceded by a wide range of symptoms, including: facial tingling, blind spots, auras, and flashes of light. Migraines are often accompanied by nausea, vomiting, and heightened sensitivity to light or sound. Cluster headaches are severe headaches that occur in clusters. They often occur during sleep, affecting the area around one eye or on one side of the head. Like ice pick headaches, they strike suddenly, but are often preceded by migraine symptoms or by a migraine headache. They can occur in clusters over an extended period, ranging from weeks to months. In addition to extreme pain, symptoms include: tearing and redness of one eye, a drooping eyelid, swelling around the eye, and a stuffy or runny nose. Ice pick headaches also differ from Tension headaches, which generate mild to moderate pain, which may surround the entire head like a vice.


The underlying cause of ice pick headaches is currently unknown but is thought to be associated with fleeting, short-term disruptions within the brain’s central pain control mechanisms. Although ice pick headaches were thought to be relatively rare, recent research indicates that it occurs in 2 to 35 percent of the population. It also occurs more frequently in women with an average onset age of 28 years old. Ice pick headaches occur in two forms, primary or secondary. If they’re primary, it means they occur without any other apparent cause. Conditions such as Bell’s palsy or shingles (herpes zoster) can lead to secondary ice pick headaches. People who get migraine headaches or cluster headaches get ice pick headaches more frequently than the average person does. Like ice pick headaches, cluster headaches don’t have any specific, known triggers. People who get migraines as well as ice pick headaches, may have more success in determining their triggers. These can include: stress, disruptions in sleep pattern or routine, alcohol, hormonal changes, and food additives. Ice pick headaches are sometimes categorized as primary headaches, meaning they’re caused by the headache condition and not by another associated diagnosis. Ice pick headaches may also be categorized as secondary headaches with an underlying cause. These causes include conditions, such as: Migraines. People who get migraine headaches are more likely to get ice pick headaches than the general population. They may also get ice pick headaches in the same area of the head where their migraines occur. Cluster headaches. Ice pick headaches sometimes occur at the end of a cluster headache cycle. Temporal arteritis. This condition affects the arteries which supply blood to the head and brain. If left untreated it can lead to stroke, a brain aneurism, or death. Intracerebral meningioma. A slow-growing tumor, which may occur on the brain’s surface or on the spinal cord. These types of tumors can affect various areas of the brain. Treatment options include radiation, observation, and surgery. Autoimmune disorders. One small study found a link between autoimmune disorders, such as multiple sclerosis, lupus, and autoimmune vasculitis, with ice pick headache occurrence. Bell’s palsy. Bell’s palsy is a form of temporary facial paralysis resulting from damage or trauma to the facial nerves. Shingles. Herpes zoster or shingles, is a viral infection of nerves and can lead to secondary ice pick headaches.


Ice pick headaches are so brief that they often don’t provide a window of opportunity to take medication. However prophylactic use of pain-reducing medication may make sense. Like with migraines, It helps to keep a diary, outlining your daily activities, emotions, food intake, and ice pick headache occurrence. If you’re able to identify a specific trigger, avoid it and then reintroduce it to verify the trigger may help identify the culprit. Despite their severity, ice pick headaches aren’t dangerous. They don’t require medical intervention, unless they occur frequently or interfere with your daily life. Since they occur without warning, it’s important to do what you can to avoid them if they happen with any type of frequency. This may be especially important if you operate machinery, drive a vehicle, or engage in any other activity which might cause serious consequences if you experience an unexpected stab of pain. Ice pick headaches have no specific known cause or trigger. They may be caused by malfunctions in the brain’s central pain control mechanisms. Women and people who get migraines or cluster headaches may be more likely to get ice pick headaches than other people. I hope this information can help those who get these to help find their triggers or secondary cause, but if not, know that they are not dangerous but can be very alarming.