Diagnosis

Ice pick headache

Etiology

Etiology [seu]

• Primary: unknown cause

• Secondary: herpes zoster meningoencephalitis, meningioma, stroke, and multiple sclerosis

Pathophysiology

• Unknown, several unconfirmed theories

• Trigeminal nerve disorder: Due to superficial and sharp pain

• Dysfunction in central pain control mechanisms producing neuronal activity that could be perceived as stabbing or jabbing pain

Primary headaches: Idiopathic and not caused by any underlying disease

1. Tension-type headache

2. Migraine

3. Trigeminal autonomic cephalalgias (TACs)

   • Cluster headache

   • Paroxysmal hemicrania

   • Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)

   • Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA)

   • Hemicrania continua

   • Trigeminal neuralgia

4. Other primary headache disorders

   • Primary cough headache

   • Primary exercise headache

   • Primary headache associated with sexual activity

   • Primary thunderclap headache

   • Cold-stimulus headache

   • External-pressure headache

   • Ice pick headache (Primary stabbing headache)

   • Nummular headache

   • Hypnic headache

   • New daily persistent headache

Secondary headaches: secondary to an underlying disease

1. Substance headache

   • Medication-overuse headache:

     • NSAIDs, caffeine, ergots, opioids, paracetamol, codeine, triptans

   • Headache caused by acute substance use

     • Alcohol, Cocaine, Cannabis, Carbon monoxide, Histamine, Calcitonin gene–related peptide, Phosphodiesterases, Acetaldehyde

     • Certain food additives (phenylethylamine, tyramine, aspartame, and monosodium glutamate)

     • NO donors (amyl nitrate, erythrityl tetranitrate, glyceryl trinitrate, isosorbide mononitrate or dinitrate, sodium nitroprusside, mannitol hexanitrate, pentaerythrityl tetranitrate)

     • Substances containing lead (batteries, certain paints, fuel)

     • Substances containing benzene (turpentine, spray adhesives, inks, rubber cement, and chemical solvents)

     • Headache medication (atropine, digitalis, disulfiram, hydralazine, imipramine, nicotine, nifedipine, nimodipine, sildenafil), as a common side effect occurring after occasional use

     • Headache medication (combined oral contraception, hormone replacement therapy, anabolic steroids, amiodarone, lithium carbonate, nalidixic acid, thyroid hormone replacement therapy, tetracycline, and minocycline), as a direct or indirect pharmacological effect occurring after long-term use

   • Headaches attributed to substance withdrawal

     • Caffeine, Opioids, Estrogens, Corticosteroids, Tricyclic antidepressants, SSRIs, NSAIDs

2. Headaches Attributed to Head or Neck Injuries

3. Headaches Attributed to Cranial and/or Cervical Vascular Disorder

   • Cerebral ischemic event

   • Nontraumatic intracerebral hemorrhage

   • Unruptured vascular malformation

   • Arteritis

   • Cervical carotid or vertebral artery disorder

   • Cerebral venous thrombosis

   • Other acute intracranial vascular disorder

4. Other Secondary Headaches

   • Infection/inflammation: herpes zoster meningoencephalitis, postherpetic neuralgia, multiple sclerosis

   • Psychiatric disorder

   • Temporomandibular disorder

   • Disorder of the teeth

   • Disorder of the eyes, nose, or ears

   • Arterial hypertension

   • Hypoxia and/or hypercapnia

   • Intracranial neoplasia: meningioma

   • Fasting

   • Epileptic seizure

Complications [p7k]

• Medication overuse headache

Epidemiology

Incidence per 100.000 [seu][ehh][3ss][mkp]

Approach

• Clinical diagnosis: [seu]

  • Pattern: paroxysmal, multiple times a day

  • Duration: ultra-short stab of pain lasting seconds

  • Location: usually frontal, temporal, or occipital region

  • Symmetry: either unilaterally or bilaterally

  • Other: absence of any underlying disease

• No biological markers or radiologic findings specific to the disease

Diagnostic criteria: 2 of 3 required [seu]

1. Stabs lasts only a few seconds

2. Occur with irregular frequency

3. No cranial autonomic symptom

Treatment

1. Indomethacin 50-150mg/day (NSAIDs): 35% of patients fail to show significant benefit [seu]

2. Other treatment: Gabapentin, cyclooxygenase-2 inhibitors, melatonin, and external hand warming

Differential diagnoses

Cluster headache, Herpes zoster, Nummular headache, Otitis media, Paroxysmal hemicrania, Temporomandibular syndrome, Thunderclap headache, Trigeminal neuralgia