Usually Ice-Pick Headaches
Sharp head pain happens to 2% of people each year.
The most common cause of sharp head pain is called ‘Ice-Pick Headache’.
Nothing provokes these sharp headaches and they are away as quick as they came. Sometimes there is a mild lingering dull sensation afterwards for a few minutes.
Your first step is knowing that you are not in danger. Once you know you are safe you can take many different steps to get control of symptoms.
4 meanings of Sharp Head Pain
The phrase ‘sharp head pain’ can mean different things to different people – here’s 4 meanings I encounter in my clinics.
Stabbing or Knife-like pain
Sharp may mean a stabbing pain in the head, like someone has taken a knife or needle and rammed it into the skull. An example is Ice-Pick Headache.
- Sudden and Severe Some people say ‘sharp pain’ but describe a sudden severe headache not a sensation of being struck with a knife or needle. A sudden severe headache requires urgent medical attention, whereas Ice-Pick Headache does not.
Bad or Intense
The other meaning of sharp that people use is to mean an intense bad headache.
If you use “sharp” to mean a severe headache usually the problem is Migraine Headaches.
In this instance, sharp means a brief shooting feeling called Neuralgia.
Causes of Knife-like Sharp Head Pain
Sharp Head Pains (Knife-like)
These conditions are confused with Ice-Pick Headaches:
- Cervicogenic Headache: Most people with cervicogenic headache have a pressure or throbbing sensation on one side of the head. Brief stabs of pain are common in people with Cervicogenic Headache.
Trigeminal Neuralgia: This sudden stabbing or shooting pain affects your cheek or jaw. Touch or movement trigger this intense sharp head pain. The pain is in the eye or forehead in very few cases. The pain is brief, and Carbamazepine is the drug of choice.
Trigeminal Autonomic Headaches: These headaches are very brief – often sharp – head pains accompanied by ‘autonomic activation’. Autonomic Activation means watering of the eye, a stuffy nose, reddening of the white of the eye, or swelling around the eye or face. Most of these headaches respond very well to strong anti-inflammatories such as Indometacin.
People with Cluster Headache get sharp head pains. These can occur just as a Cluster Headache is starting, during an attack and can occur between attacks. A Cluster Headache is a monstrous pain in or around one eye, accompanied by ‘Autonomic Activation’. The drugs that work best are High Flow Oxygen, Subcutaneous Sumatriptan and Verapamil.
- Paroxysmal Hemicrania: These are also sharp eye pains, although people will describe claw-like sharp pain, boring and throbbing sensations. An attack lasts 2-30 minutes. Roughly half of people pace the floor like people with cluster headache do. Some people with Paroxysmal Hemicrania lie still like people with Migraine. This headache responds to strong anti-inflammatories – classically Indometacin.
- SUNCT Syndrome: S = 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. Pain is excruciating, shock-like, pricking, piercing or burning.
Sharp Head Pains 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. SUNCT Syndrome is difficult to treat. Lamotrigine has a small chance of reducing the pain of SUNCT.
Paroxysmal Extreme Pain Syndrome (PEPS)
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. Paroxysmal Extreme Pain Syndrome runs in families due to a problem with the Sodium Ion Channel Gene (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. Inside this area of dull headache, sharp head pains occur. The scalp is tender at the site of pain, and a small circular area of hair loss can appear in the painful area. Some people who have Shingles (Herpes Zoster Reactivation) affecting the scalp experience nummular headaches.
Causes of Shooting Type Sharp Head Pain
Neuralgia is another word for Shooting Sharp Head Pains.
Sharp Shooting Pains in the Head affect any of the named nerves in the head.
The worst and most common disorder is Trigeminal Neuralgia.
The other neuralgias are:
- Occipital Neuralgia – shooting pain in the back of the head
- Supra-orbital Neuralgia – shooting pains above one eye – sometimes due to a tight pair of goggles or helmet.
- Auriculotemporal Neuralgia – shooting pains in front of the ear and up the side of the head
- Nervus Intermedius Neuralgia – a deep shooting pain inside the ear or back of throat
- Sphenopalatine Neuralgia – shooting pain in the back of the throat
- Infra-orbital Neuralgia – shooting pain under one eye
- Glossopharyngeal Neuralgia – severe shooting pain in the throat provoked by swallowing
- Superior Laryngeal Neuralgia – severe shooting throat pain
- Naso-ciliary Neuralgia – sharp pain over the tip of the nose
- Third Occipital Neuralgia – sharp pains in the back of head and top of neck
Sharp Head Pain Provoked by Cough, Exercise, Sleep, Sex or Cold Temperature
Sometimes “sharp pain” describes a pain provoked by a particular action.
Ice-Pick Headaches are unprovoked. Here are the provoked sharp head pains:
Exertional Headache is described as an explosive or pulsating headache. However it may be described as “sharp”.
Sinus disease, Subarachnoid Haemorrhage and raised intracranial pressure are causes of exertional headache. Angina can cause an exercise induced headache called Cardiac Cephalalgia.
However, most people with exertional headache do not have a cause identified.
Always investigate an Exertional Headache – ideally with an MRI of Head.
Hypnic Headache wakens you from sleep. Going to bed, you are is pain free, only to be woken at the same time every night. The pain of Hypnic Headache is intense, diffuse and lasts anything from 30 to 180 minutes.
If you fall asleep after an episode of Hypnic Headache you may be woken again later by another attack.
Lithium Carbonate is the drug of choice 70% responding. Caffeine helps many people with Hypnic Headaches.
Headaches During Sex
Headaches during sex build up as sexual often described as a sharp head pain. A serious cause such as subarachnoid haemorrhage needs to be ruled out after a first episode of orgasmic headache.
The most common cause 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.
- Brain Freeze
Eating ice-cream or an iced drink induces intense sharp head pain as every school child knows.
The technical term is ‘cold-stimulus headache’ which is more common in people with migraine.
What to do about Sharp Head Pain
In most cases you have Ice-Pick Headaches, and in the background lurks Migraine, Tension-Type Headache or Cluster Headache. If you have any of these three headaches you manage these headaches in a standard manner and the sharp head pains usually reduce.
If you are free from rarer headaches, and do not suffer Migraine, Tension-Type Headache or Cluster Headache, it is likely you have Ice-Pick Headache. At worst you may need strong painkillers prescribed by your doctor.
If you struggle with headaches you need to know that you are safe – it’s your first step.
If your main headache is Migraine consider following The Headache Friendly Lifestyle™.
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by Dr Raeburn Forbes MD(Hons)
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