4.7 Primary stabbing headache

Previously used terms:

Ice-pick pains; jabs and jolts; needle-in-the-eye syndrome; ophthalmodynia periodica; sharp short-lived head pain.


Transient and localized stabs of pain in the head that occur spontaneously in the absence of organic disease of underlying structures or of the cranial nerves.

Diagnostic criteria:
  1. Head pain occurring spontaneously as a single stab or series of stabs and fulfilling criteria B and C
  2. Each stab lasts for up to a few seconds1
  3. Stabs recur with irregular frequency, from one to many per day2
  4. No cranial autonomic symptoms
  5. Not better accounted for by another ICHD-3 diagnosis.
  1. Studies show 80% of stabs last 3 seconds or less; rarely, stabs last for 10-120 seconds.
  2. Attack frequency is generally low, with one or a few per day. In rare cases, stabs occur repetitively over days, and there has been one description of status lasting one week.

Field testing has confirmed the validity of these diagnostic criteria for 4.7 Primary stabbing headache. They enable the diagnosis of most primary headaches characterized by stabbing pain, which were not classified in ICHD-II.

4.7 Primary stabbing headache involves extratrigeminal regions in 70% of cases. It may move from one area to another, in either the same or the opposite hemicranium: in only one third of patients it has a fixed location. When stabs are strictly localized to one area, structural changes at this site and in the distribution of the affected cranial nerve must be excluded.

A few patients have accompanying symptoms, but not including cranial autonomic symptoms. The latter help to differentiate 4.7 Primary stabbing headache from 3.3 Short-lasting unilateral neuralgiform headache attacks.

4.7 Primary stabbing headache is more commonly experienced by people with 1. Migraine, in which cases stabs tend to be localized to the site habitually affected by migraine headaches.