Sharp Pain in Head - what is it?
Each year at least 2% of people describe a "sharp pain in head".
One survey from Scandanavia looked very closely for people who would not have seen a doctor about their head pain and found that 35% of people will have experienced a sharp head pain at some time in their lives.
It is a very common headache symptom and causes a lot of alarm.
A "Sharp Pain in Head" means different things to different people.
Sudden and Severe
- Bad or Intense
- Some people use "sharp" to mean a bad headache. If I try to get a description of stabbing or shooting from a person's history and they insist sharp pain in head just means "bad headache" it usually turns out that they have migraine.
To diagnose migraine other features, particularly sensory sensitivity must be present (i.e. intolerance of light, movement, noise or smell and/or nausea).
- Stabbing or Knife-like
- To other people a "sharp pain in head" means it was a sudden severe headache, and it does not actually have a knife-like or needle-like quality.
People who use the word sharp this way often have a throbbing or pressure-type headache, if the question is put in more direct terms.
A sudden and severe headache requires urgent medical attention, as there are potentially serious causes.
- Sharp can also be taken to mean a brief shooting feeling. Shooting pains are often labelled as Neuralgia.
They are very brief, and may feel like they trqavel through or over part of the head. If triggered by touch they are usually called neuralgia. The phrase "neuralgiform" is taken to mean a shooting, severe pain
Causes of Sharp Pain in Head
The causes of a sharp pain in head, which I usually interpret as a shooting or stabbing pain are (in approximate order from most to least common):
- Ice-pick Headache
- Ice-pick headache is usually more of a nuisance than a significant problem.
Ice-pick Headaches describe a sudden, brief pain lasting seconds which is usually happens in or around one eye.
There are no other symptoms. They are not ptovoked by touch, cough, exertion or movement.
They occur occasionally, maybe a few times a month, or as often as 10 or more per day.
Treatment is only considered if the pain stops you in your tracks several times per day, or if a drop attack occurs. Drop attacks literally mean that you go weak at the knees and fall to the ground at the same time as the intense sharp pain in head.
The treatment long regarded as best is Indometacin (25 to 75mg three times daily)), but the evidence of this is clinical experience rather than a proper randomised clinical trial.
Indometacin is a prescription only drug due to the risk of causing stomach ulceration.
- Although most people with cervicogenic headache will describe a pressure/tight sensation, brief stabs of pain are commonplace.
Pains in cervicogenic headache are only on one side of the head, and the shhoting sharp pains of cervicogenic headache are usualy on the same side as the rest of the pain. They will often travel from the back of the head to the ear, behind the ear, front of neck, round the head to above the eye, or shhot right through to the eye.
If the C2 nerve root is under pressure by a diseased lateral atlanto-axial joint at the top of the neck, rotation of the head can trigger intense pain or even spasm of the tongue, called neck-tongue syndrome.
Trigeminal Autonomic Headaches
- The pain in Trigeminal Neuralgia is a sudden shooting pain usually over the cheek or jaw.
Trigeminal Neuralgia is triggered by touch, including swallowing, eating, brushing teeth, shaving or by a breeze across the face.
In only a few cases the pain is in the eye or forehead. The pain can be a very brief sensation and there is a pain free period of minutes until the next pain.
Alternatively it can appear as repeated sharp stabs or shots of pain with very little pain free time between.
Another group will feel that there is always an underlying dull pain in the face with bouts of sharp pains on top of this.
Carbamazepine is the drug of choice.
Trigeminal neuralgia can be confused with the rare condition called SUNCT, especially in cases where the sharp pain is around the eye
Paroxysmal Extreme Pain Syndrome (PEPS)
- These headaches are all related to cluster headache. In common they are usually produce a sharp pain in head that is centred in or around the eye.
There are also "autonomic features": a watery eye, blocked or running nose, reddening of the white of the eye, or drooping of the upper eyelid on the same side as the pain.
The Trigeminal Autonomic Headaches are:
- Cluster HeadacheSevere intense pain at its worst within 5 minutes. Pain is often describe as "boring". Each attack of head pain lasts 30-180 minutes. It can return several times per day. Sharp pains on top of the severe boring pain are very common.People are agitated, pace the floor, bang their head off the wall, scream or have suicidal thoughtscluster.Best treatments: high flow oxygen, sumatriptan injections and verapamil
- Paroxysmal HemicraniaThese are also sharp eye pains.People will describe claw-like sharp pain, boring and throbbing sensations. An attack lasts 2-30 minutes.Roughly half of people will pace the floor like people with cluster headache.The other half will lie still like people with Migraine.Features of Migraine like nausea and intolerance of light are fairly common in Paroxysmal Hemicrania.Best treatment: Indomethacin.
- SUNCT SyndromeS = Sudden, U = Unilateral (one-sided), N = Neuralgiform headache, C = Conjunctival injection (reddening of the white of the eye), T = Tears.Each individual pain spike in SUNCT last from 5 seconds to 5 minutes.SUNCT is very rare. I've only seen a few cases in the last 7 years.Pain is usually excruciating, shock-like, pricking, piercing or burning.Pain spikes can come in runs lasting up to 20 minutes.There are also people who will have up to 3 hours of moderate background pain with very frequent spikes of pain on top of this.Best treatment: Lamotrigine has only a fair chance of relieving the pain.
- PEPS can cause bouts of severe sharp eye pain. In PEPS there are also bouts of jaw or rectal pain.Flushing of the skin of face or bottom occurs. The condition runs in families due to a problem with the Sodium Ion Channel (SCN9A).
- This causes pain in a localised area of the scalp ("nummular" means coin).The pain can be dull, and pressure-like, which leads to a mis-diagnosis of tension-headache.
On top of this background, sharp pain in head at one site usually occur. The scalp can be tender at the site of pain.
A small circular area of hair loss occurs in some cases.
This is not usually serious. Best treatment: do nothing, but Gabapentin, Indometacin and botulinum toxin injections have all been reported in individuals as effective
The Neuralgias can cause Sharp Pains in the Head
Shooting type Sharp Head Pains are usually referred to as neuralgia.
Shooting Pains in the Head can affect any individual named nerve in the head.
The worst disorder is arguably Trigeminal Neuralgia.
They cause pain in the territory of the nerve concerned and can often be triggered by touching the affected area, especially trigeminal neuralgia.
The other named neuralgias are:
- Occipital Neuralgia
- Supra-orbital Neuralgia
- Auriculotemporal Neuralgia
- Nervus Intermedius Neuralgia
- Sphenopalatine Neuralgia
- Infra-orbital Neuralgia
- Glossopharyngeal Neuralgia
- Superior Laryngeal Neuralgia
- Naso-ciliary Neuralgia
- Third Occipital Neuralgia
Any funny sharp, shooting pain in the eye, head, ear, throat or neck should have one of these diagnoses considered.
A trial of Carbamazepine up to 400mg twice daily is often recommended, on the basis that the drug works well in trigeminal neuralgia.
What about a Sharp Pain in Head Provoked by Cough, Exercise, Sleep, Sex or Cold Temperature?
Sometimes "sharp pain in head" is provoked by a particular action.
However, Ice-pick Headaches are unprovoked. I always ask about provocation when listening to someone tell me about sharp head pain. The reason for this is that these provoked headaches have a completely different range of possible causes.
That's a short introduction to "Sharp Pain in Head" - read more about What Causes Headaches.
Severe Headache Expert Home Page
- Cough HeadacheThis sharp pain in head is exclusively provoked by coughing.
The pain is sharp, bursting or stabbing and affects both sides of the head.
Chiari Malformation is the most common cause found. This headache always should be investigated for an underlying cause.
- Exertional HeadacheExertional Headache is usually described as an explosive or pulsating headache.
However it may be described as "sharp".
Sinus disease, Subarachnoid Haemorrhage and raised intracranial pressure are known causes of exertional headache. Angina can cause an exercise induced headache called Cardiac Cephalalgia.
However, most people with exertional headache will have no cause found.
Exertional Headache should always be investigated.
- Hypnic HeadacheThis headache wakens you from sleep. Going to bed, the person with Hypnic Headache is pain free.However, they are woken at the same time every night with an intense, diffuse headache that lasts from 15-20 minutes.
If someone falls to sleep after an episode of headache they can be woken again later on by the same pain.
Lithium Carbonate is the drug of choice with a 70% repsonse rate in my own patients and in published reports.
- Headaches During SexHeadaches during sex will either build up as sexual excitement intensifies (pre-orgasmic), or can occur as a sudden severe headache on orgasm (orgasmic headache).
They are usually pulsating in quality, but could very easily be described as a sharp pain in the head. A serious cause such as subarachnoid haemorrhage needs to be ruled out after a first episode of orgasmic headache.
The most common cause of sex headache is Reversible Cerebral Vasoconstriction Syndrome (RCVS), which causes bouts of painful spasm of arteries in the brain.
RCVS takes several weeks or months to resolve, during which time it may be associated with severe headache on at least 50% of sexual activity episodes.
- Brain FreezeEating ice-cream or an iced drink can induce an intense sharp pain in the head.
The technical term is cold-stimulus headache. People with migraine are more likely than average to get this pain.