Treating Ice Pick Headache

Treating ice pick headache is not difficult - usually it is the diagnosis that causes a problem. Usually the first step is to explain the condition. This should reassure the patient (and referring doctor) as often the sudden pain can make them think there has been a catastrophic event in the brain such as a haemorrhage. Although unpleasant, ice pick pains are usually more of a nuisance than a disabling disorder. In people with very frequent attacks of pain the following are usually recommended:

1. Indomethacin 25 to 150mg daily
This is a very powerful anti-inflammatory medicine, and should not be used in someone with known peptic ulceration of the stomach or duodenum. Asthma can also be exacerbated by use of this type of medication. It should only ever be used on prescription by your doctor. The response to Indomethacin can be dramatic, although my own experience is perhaps more like a 50:50 response.
2. Gabapentin up to 1800mg per day
I will often use Gabapentin in conjunction with a course of Indomethacin for ice-pick pains. I usually give the Indomethacin for 5 or 7 days at a dose of 25mg three times daily, and start the Gabapentin at 300mg daily, increasing by 300mg per week till an effective dose or a max of 600mg three times daily. The main problem with Gabapentin is that it can make you quite sleepy.
3. Melatonin 3mg
Melatonin is a naturally occurring hormone which regulates sleep. For some reason it does help some severe headache disorders, the classic one being hypnic headache. However, if someone is not able to take Indomethacin, this can be used.