At least 2% of people get sharp head pain each year.
However, the real figure may be closer to 35% – it depends where, and how hard, you look!
For most people a sharp pain in head is a nuisance, rather than a serious problem, and is due to Ice-pick Headache.
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 occur occasionally, maybe a few times a month, or as often as 10 or more per day.
Nothing provokes these sharp headaches and they are away as quick as they came. Sometimes there is a mild lingering dull sensation afterwards.
However, if you have a recurrent, severe sharp head pain, you will want something done about it.
So here are the causes of a sharp head pain, and the features that tell the difference between them.
“Sharp Pain” Can Mean Different Things to Different People.
I find that the 4 uses of the word “Sharp” in my own clinics are:
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.
Sudden and Severe
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.
In fact people who use the word sharp this way often have a throbbing or pressure-type headache.
A sudden severe headache requires urgent medical attention, as there are potentially serious causes.
Bad or Intense
The other meaning of sharp that people use is to mean an intense bad headache.
I often find that when people use “sharp” to mean a bad headache they often turn out to have Migraine Headaches.
Sharp can also be taken to mean a brief shooting feeling.
Shooting pains are often called Neuralgia
Causes of Knife-like Sharp Head Pain
Sharp Head Pains (Knife-like)
The most common cause of these are Ice-pick Headaches.
These conditions can be confused with Ice-pick Headache (but are much rarer):
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.
The pain in Trigeminal Neuralgia is a sudden stabbing or 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 Autonomic Headaches
These headaches are all related to cluster headache. In common they are usually in or around the eye and have “autonomic features”.
By “Autonomic Features” I mean eye-watering, congestion of the nose, reddening of the white of the eye, or drooping of the upper eyelid on the same side as the pain.
These headaches are also one-sided only
Severe 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.
People are agitated.
They may pace the floor, bang their head off the wall, scream or have suicidal thoughts during a cluster attack.
These pains happen every day for a few weeks and then disappear for months or years hence the term cluster.
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 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.
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.
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.
SUNCT Syndrome is difficult to treat. Lamotrigine has only a fair chance of relieving the pain
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. 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 pains usually occur. The scalp can be tender at the site of pain.
A small circular area of hair loss occurs in some cases.
Causes of Shooting Type Sharp Head Pain
Sharp Head Pains (Shooting) A Sharp Head Pain that is brief and shooting is usually referred to as neuralgia. Sharp Shooting Pains in the Head can affect any individual named nerve in the head.
The worst disorder is arguably Trigeminal Neuralgia.
The other 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
Sharp Head Pain Provoked by Cough, Exercise, Sleep, Sex or Cold Temperature
Sometimes “sharp pain” is used to described a pain 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.
This headache 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.
Exertional 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 Caphalalgia.
However, most people with exertional headache will have no cause found.
Exertional Headache should always be investigated.
This 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 Sex
Headaches 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 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 found 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.
Eating 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.