A4.11 Epicrania fugax


Brief paroxysmal head pain, with stabbing quality, describing a linear or zig-zag trajectory across the surface of one hemicranium.

Diagnostic criteria:
  1. Recurrent stabbing head pain attacks lasting 1-10 seconds and fulfilling criterion B
  2. Pain moving with a linear or zig-zag trajectory across the surface of one hemicranium, commencing and terminating in the distributions of different nerves
  3. Not better accounted for by another ICHD-3 diagnosis1.

A structural lesion must be excluded by history, physical examination and, when appropriate, investigation.


Patients with A4.11 Epicrania fugax describe their pain in terms of its trajectory between two distant points on the head surface, with motion from onset to termination taking just a few seconds. Such dynamic topography is a distinctive attribute that differentiates A4.11 Epicrania fugax from other epicranial headaches and neuralgias. The onset and termination points remain constant in each patient, with pain usually moving forward from a posterior hemicranial area towards the ipsilateral eye or nose, but backward radiation is also possible from a frontal or periorbital area towards the occipital region. In all cases, pain is strictly unilateral, although some patients have shifting sides.

At the end of attacks, ipsilateral autonomic signs such as lacrimation, conjunctival injection and/or rhinorrhoea may occur.

Although attacks are mostly spontaneous, they may occasionally be triggered by touch on the point of onset, which may remain tender between attacks.