Idiopathic Stabbing Headache Research Articles

The epidemiology of headache disorders: a face-to-face interview of participants in HUNT4

BackgroundThe primary aim of this cross-sectional population-based study was to evaluate the 1-year prevalence of common headache disorders by a face-to-face interview.MethodsThe fourth wave of Nord-Trøndelag Health Survey (HUNT4) started in September 2017. The study was undertaken as part of a project mainly focusing on sleep disorders, where a total of 232 (19.3%) out of 1200 invited HUNT4 participants underwent a face-to-face headache interview.ResultsThe mean age of the 232 participants was 58.4 years (range 22–89). There were 71.6% (95% CI 65.7–77.4) who reported headache during the last year, and 18.5% (95% CI 13.5–23.6) had suffered from headache in the same period. The 1-year prevalence of tension-type headache (TTH) was 43.1% (95% CI 36.7–49.5), of idiopathic stabbing headache 34.1% (27.9–40.2), and of definite migraine 18.1% (95% CI 13.1–23.1). A total of 7.6% (95% CI 4.0–10.7%) had migraine with coexisting TTH. Lifetime prevalence of migraine was 32.8% (95% CI 26.7–38.8). Headache yesterday was reported by 12.1% (95% CI 7.9–16.3), and 5.6% (95% CI 2.6–8.6) had headache during the interview.ConclusionIn this population-based cross-sectional headache study performed by a face-to-face interview, the 1-year prevalence of TTH was 43.1% and of idiopathic stabbing headache 34.1%. A total of 18.1% had active migraine (18.1%), whereas the lifetime prevalence of migraine was 32.8%.

Idiopathic Stabbing Headache Can Occur in Children with Chronic Daily Headache: Frequency, Characteristics and Treatment (P1.166)

Idiopathic Stabbing Headache Can Occur in Children with Chronic Daily Headache: Frequency, Characteristics and Treatment (P1.166)

Abdominal and Lower Back Pain in Pediatric Idiopathic Stabbing Headache

Idiopathic stabbing headache (ISH) is a primary headache syndrome characterized by transient, sharp, stabbing pains located in the first division of the trigeminal nerve. Reports of pediatric ISH are rare, and extracephalic pain in pediatric ISH is extremely rare. Here we report the case of a 7-year-old male patient suffering from frequent, short, stabbing headache, which was occasionally associated with abdominal and lower back pain. Various investigations were normal. He was diagnosed with ISH, and valproic acid was administered to relieve his headache and accompanying symptoms. Our case demonstrates that abdominal and lower back pain may occur in pediatric ISH. This case may provide new evidence linking ISH and migraine by showing that extracephalic symptoms accompanying ISH are similar to those of migraine. We hypothesize that the mechanism underlying the headache and abdominal and lower back pain associated with ISH may be similar to that of a migraine headache. Accumulating additional cases by asking specific questions regarding the presence of the unusual symptoms presented in our case may help to establish a detailed clinical profile of these unfamiliar and peculiar symptoms in the pediatric ISH population.

Pediatric-Onset Extracephalic Stabbing Pain

Idiopathic stabbing headache is a primary headache defined as "transient stabs of pain in the head that occur spontaneously in the absence of underlying organic disease." Although its variant form, stabbing pain with extracephalic distribution, has been reported in rare adult cases, pediatric presentation is extremely rare. We report an 8-year-old boy suffering from severe stabbing pain in the left side of the chest, right side of the abdomen, and right knee lasting 2 to 3 minutes with increasing frequency. He was completely normal between attacks. The attack was not accompanied with headache initially. Investigation showed no abnormality. A diagnosis of extracephalic stabbing pain was made. The patient's symptoms were ameliorated by administration of valproic acid. This report illustrates that extracephalic stabbing pain can occur in pediatric patients. It is important to be aware of this peculiar condition because the pain is so severe, and it can be treatable with medication.

Characteristics of primary exertional headache in Korean marine corps

Primary exertional headache is included in Other Primary Headaches (Group 4) in the International Classification of Headache Disorders, 2nd edition (ICHD-II) with primary cough headache, primary sexual headache, and idiopathic stabbing headache. The prevalence of primary exertional headache showed about 1-30.4%.

Prevalence and Burden of Headaches as Assessed by the Health Family Program

Unified health systems often have Family Health Programs (FHPs) as a core component of their preventive and early curative strategies. In Brazil, the FHP is established to proactively identify diseases such as diabetes and hypertension. To use the FHP in order to assess the prevalence of primary headaches, as per the Second Edition of the International Classification of Headache Disorders in a Brazilian city covered by the program, and to document the burden of migraine and tension-type headache (TTH) in this population. FHP agents were trained on how to apply questionnaires that screened for the occurrence of headaches in the past year. Screening method had been previously validated. Respondents that screened positively were interviewed by a headache specialist, and all their headache types were classified. Additionally, disability (Migraine Disability Assessment Scale and Headache Impact Test) and health-related quality of life were assessed. The 1-year prevalence of migraine was 18.2% [95% confidence interval = 13.7; 23.5]. TTH occurred in 22.9% [18.0%; 28.6%]. Other primary headaches occurred in 10.8% of the participants. Idiopathic stabbing headache was significantly more common in individuals with migraine relative to those without migraine (44.7% vs 10.3%, P < .001). Contrasting with TTH, migraineurs had a mean of 3.1 headache types vs 1.9 in TTH (P < .001). Secondary headaches occurred in 21.7% of the participants over a 1-year period [16.9%; 27.3%]. Most cases were headaches attributed to infection (mostly respiratory). The impact of migraine was bimodal. Most sufferers had little impact, but a sizable minority was severely impaired. The FHP can be effectively used to bring individuals with headache to the attention of providers. Future investigations should assess whether this increased attention translates into improved outcomes.

The “Other” Headaches: Primary Cough, Exertion, Sex, and Primary Stabbing Headaches

Primary cough headache, primary exertional headache, primary sexual headache, and idiopathic stabbing headache are included in "Other Primary Headaches" (Group 4) in the International Classification of Headache Disorders, 2nd edition (ICHD-II). Headaches provoked by cough, exertion, and sex have different age distributions, but they do share some clinical and pathogenic characteristics. The triggering activities frequently involve Valsalva-like maneuvers, which may explain part of the pathogenesis. Primary stabbing headache is common and characterized by ultra-short stabbing headaches. All these headache disorders respond well to indomethacin, and they are commonly comorbid with migraine except for primary cough headache. Of note, some patients with sexual headache had reversible cerebral vasoconstriction syndromes. Recent large-scaled studies have revealed that the ICHD-II criteria of these four headache disorders cannot be completely fulfilled. Further revisions for the ICHD-II criteria are required based on these results of the evidence-based studies.

The use of etoricoxib to treat an idiopathic stabbing headache: a case report.

According to the International Headache Society, idiopathic stabbing headache (ISH), an indomethacin-responsive headache syndrome, is a paroxysmal disorder of short duration manifested as head pain occurring as a single stab or a series of stabs involving the area supplied in the distribution of the first division of the trigeminal nerve. Stabs last for approximately a few seconds, occurring and recurring from once to multiple times per day in an irregular frequency, with no underlying attributable disorder.Previously indomethacin was the principle treatment option for ISH, despite therapeutic failure in up to 35% of cases, until reports showed gabapentin, melatonin and selective cyclo-oxygenase-2 (COX-2) inhibitors were also possibly effective. In this report we present the full case report of an 88 year old lady with a history of untreated ISH where etoricoxib, a selective COX-2 inhibitor, was used to effectively treat her ISH.

Short-Lasting Headaches in Children

Short-lasting headaches have been studied infrequently in children and it is not known if the main categories of primary headaches of this type in adults are applicable to children. We report our experience with a group of 20 children with a brief headache. Two patients had a secondary headache. One patient had a headache with some clinical characteristics of paroxysmal hemicrania. The remaining 17 had a very brief headache. They were in many aspects comparable to others from previous studies on idiopathic stabbing headache in children: no associated symptoms, no other associated headache, frequent family history of migraine. They differed, however, in the younger age of the patients and the more frequent extratrigeminal location of the pain. Extratrigeminal ice-pick pain may be a variant of idiopathic stabbing headache, more prevalent in young children.

Recurrent and chronic headaches in children below 6 years of age

The objective was to determine the frequency of headache subtypes, according to International Headache Society (IHS) criteria, in a population of children below 6 years visiting a Center for Diagnosis and Treatment of Headache in Youth. Medical records of the children below 6 years at their first visit, admitted for headache between 1997 and 2003, were studied. Headache was classified according to the IHS criteria 2004. Children with less than three headache attacks or less than 15 days of daily headache were excluded. We found 1598 medical records of children who visited our Headache Center in the study period. One hundred and five (6.5%) were children younger than 6 years. The mean age at the first medical control was 4.8±1.3 years (range 17–71 months). There were 59 males (56.1%) and 46 females (43.9%). The mean age at onset of headaches was 4.3 years (range 14–69 months). According to the IHS criteria we found 37 cases (35.2%) with migraine, 19 cases (18%) with episodic tension headache, 5 cases (4.8%) with chronic daily headache, 13 cases (12.4%) with primary stabbing headache, 18 cases (17.1%) with post–traumatic headache, 7 cases (6.6%) with other non–dangerous secondary headaches (otorhinolaryngological diseases, post–infectious headaches), 3 cases (2.85%) with dangerous headaches (Arnold–Chiari type 1 malformation, brain tumour) and 9 cases (8.6%) with unclassifiable headaches. Six children (5.7%) reported more than one headache subtype. The prevalence of dangerous headaches was higher than those in school age (χ2=4.70, p<0.05). Our study shows some differences in headaches in this population vs. school children. In fact at this age migraine is the most common headache, but we also found an increase of secondary causes among the chronic/recurrent and daily headaches, especially posttraumatic disorders and potentially dangerous headaches. Finally our study shows the highest prevalence of the idiopathic stabbing headache in pre–school children in comparison with other ages.

Primary chronic daily headache in a clinic-based study

Objective. To determine the frequency of primary chronic daily headache (pCDH) in a clinic-based study. Study design. Data from 3,214 patients were collected and analyzed retrospectively (January 1999 to April 2004). All cases of primary chronic daily headache were divided according to gender, age, diagnosis, and headache duration1Silberstein S.D. et al.Classification of daily and near-daily headaches: field trial of revised IHS criteria.Neurology. 1996; 47: 871-875Google Scholar (longer than 4 hours: transformed migraine, chronic tension-type headache, new daily persistent headache, and hemicrania continua; or shorter than 4 hours: cluster headache, chronic paroxysmal headache, hypnic headache, and idiopathic stabbing headache). Results. Prevalence of pCDH was 31.4% (n = 1,010), 82.1% women (n = 830) and 17.9% men (n = 180). For both men and women, peaks of age were between 40 and 49 years. Transformed migraine and chronic tension-type headache had almost the same prevalence, respectively 45.3% (n = 458) and 45.2% (n = 457). The prevalence of the other types was 9.5%. Conclusion. Prevalence of pCDH in general clinics ranges from 32.8% to 75%, corresponding to 40% of the total visits in neurological clinics. Transformed migraine is the most prevalent headache in the pCDH group (77% to 90%). In the Division for Investigation and Treatment of Headaches, data confirm the high prevalence of pCDH among all headaches and suggest that chronic tension-type headache may be as prevalent as transformed migraine in the chronic daily headache group.

PEDIATRIC HEADACHE

Fusco C, Pisani F, Faienza C. Idiopathic stabbing headache: clinical characteristics of children and adolescents. Brain Dev. 2003;25:237‐240. Very few cases of short‐lasting headaches have been reported in children and adolescents. The aim of this study is to describe a group of patients in the pediatric age group with short attacks of head pain and to demonstrate that they are not easily classified according to existing criteria for adults. We describe 23 subjects in retrospect, 12 males and 11 females, with brief attacks of headache, stabbing in nature, self‐limited, lasting from a few seconds to 15 min. This sample was taken from a total population of 548 children and adolescents referred to our Pediatric Headache Unit during the years 1995‐1999. Mean age at onset of symptomatology was 9 years. The localization of the headache was bilateral in 60% of the patients and unilateral in 40%. The pain was either unifocal at the orbit or temple (60%) or multifocal (40%). In 24% of the children, the interictal awake EEG showed infrequent posterior slow‐waves. In 12 patients we used paracetamol with a good response. Although these painful episodes shared some aspects with the adult form of idiopathic stabbing headache, they had different durations of attack, and other primary headache syndromes did not accompany them either at the time of presentation or during the following 2 years. Short attacks of headache are present in the pediatric age group and are not easily classified according to the International Headache Society criteria. Their nature and correlation with migraine remains unclear. We propose follow‐up of these subjects to obtain a better description of the natural history of these forms of headache in the pediatric age group. Comment: An additional question: will all indomethacin‐responsive syndromes be clinically different in children? SJT

Idiopathic Stabbing Headache and Experimental Ice Cream Headache (Short-Lived Headaches)

Idiopathic stabbing headache (ISH) and ice cream headache occur due to paroxysmal firing of trigeminal pathways and a defect in pain control mechanisms. Any defect in pain control mechanisms appears to be localized to the affected areas. Therefore, we compared ISH and experimentally induced ice cream headache localizations in the same group of migraine sufferers to investigate similarities and differences between these headaches. The percentage of ice cream headache localizations restricted to ‘in front of the vertex/on the vertex’ was 94%, while it was 45% for ISH. The percentage of ice cream headache occurrence behind the vertex was 6% and 55% for ISH. Due to the widespread distribution of ISH in the head, there might be irritation of various branches of the trigeminal nerve, while the restricted localizations of ice cream headache suggest irritation of a certain branch or branches of the trigeminal nerve, e.g. in the oropharynx. Either widespread or restricted irritation of trigeminal pathways causes either ISH or ice cream headache, in which intermittent deficits in central pain control mechanisms seem to be playing the key role.

Nummular headache, trochleitis, supraorbital neuralgia, and other epicranial headaches and neuralgias: the epicranias

Nummular headache is characterized by mild to moderate, pressure-like head pain exclusively in a small, rounded or oval area without underlying structural lesions. Either during symptomatic periods or interictally, the affected area shows a variable combination of hypoesthesia, dysesthesia, paresthesia, tenderness or discomfort. The particular topography and signs of sensory dysfunction suggest that nummular headache is an extracranial headache probably stemming from epicranial tissues such as the terminal branches of sensory nerves. Apart from nummular headache, other headaches and neuralgias such as idiopathic stabbing headache, trochleitis, supraorbital neuralgia, external compression headache, nasociliary neuralgia, occipital neuralgias, and auriculotemporal neuralgia have temporal or spatial features that suggest a peripheral (extracranial) origin, i. e. stemming from the bone, scalp, or pericranial nerves. Common to these disorders is a focal localization or a multidirectional sequence of paroxysms, paucity of accompaniments, tenderness on the emergence or course of a pericranial nerve or on the tissues where pain originates, and possible presence of symptoms and signs (including effective treatment with locally injected anesthetics or corticosteroids) of nerve dysfunction. These observations led to the emergence of a conceptual model of head pain with an epicranial origin that we propose to group under the appellation of epicranias (headaches and pericranial neuralgias stemming from epicranial tissues). Nummular headache is the paradigm of epicranias. Epicranias essentially differ from other primary headaches with an intracranial origin and features of visceral pain, i. e. splanchnocranias that are characterized by a painful area wider than that of epicranias, no clear borders, presence of autonomic features, regional muscle tension, and driving of the process from the brain and brainstem.

Melatonin as treatment for idiopathic stabbing headache

Idiopathic stabbing headache, also termed ice pick or jab and jolts headache, consists of short-lasting stabs of sudden, severe pain lasting typically for less than 1 second. The pain can occur anywhere on the head but normally involves the orbit, temple, or parietal region.1 Spikes of pain may occur once a day or up to 50 times per day at irregular or regular intervals. Attacks may occur daily or just once in a year. The individual stab of pain is so severe and so sudden in onset that a sufferer will immediately stop any activity and grimace. With chronic daily idiopathic stabbing headache there can develop a fear of pending attacks. Idiopathic stabbing headache is associated with migraine, cluster, and hemicrania continua.2 Each spike of pain cannot be treated individually because of its short duration but if the pain spikes are occurring multiple times per day a preventive medication is required. Ice pick headaches are considered one of the …

Idiopathic stabbing headache: clinical characteristics of children and adolescents

Very few cases of short-lasting headaches have been reported in children and adolescents. The aim of this study is to describe a group of patients in the pediatric age group with short attacks of head pain and to demonstrate that they are not easily classified according to existing criteria for adults. We describe 23 subjects in retrospect, 12 males and 11 females, with brief attacks of headache, stabbing in nature, self-limited, lasting from a few seconds to 15 min. This sample was taken from a total population of 548 children and adolescents referred to our Pediatric Headache Unit during the years 1995–1999. Mean age at onset of symptomatology was 9 years. The localization of the headache was bilateral in 60% of the patients and unilateral in 40%. The pain was either unifocal at the orbit or temple (60%) or multifocal (40%). In 24% of the children, the interictal awake EEG showed infrequent posterior slow-waves. In 12 patients we used paracetamol with a good response. Although these painful episodes shared some aspects with the adult form of idiopathic stabbing headache, they had different durations of attack, and other primary headache syndromes did not accompany them either at the time of presentation or during the following 2 years. Short attacks of headache are present in the pediatric age group and are not easily classified according to the International Headache Society criteria. Their nature and correlation with migraine remains unclear. We propose follow-up of these subjects to obtain a better description of the natural history of these forms of headache in the pediatric age group.

SUNCT Syndrome: diagnosis and treatment.

8: CNS Drugs. 2002;16(6):373‐383Short‐lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing (SUNCT) is a syndrome predominant in males, with a mean age of onset around 50 years. The attacks are strictly unilateral, generally with the pain persistently confined to the ocular/periocular area. Most attacks are moderate to severe in intensity and burning, stabbing or electrical in character. The mean duration of paroxysms is 1 minute, with a usual range of 10 to 120 seconds (total range 5 to 250 seconds). Prominent, ipsilateral conjunctival injection and lacrimation regularly accompany the attacks. Nasal stuffiness/rhinorrhoea are frequently noted. In addition, there is subclinical forehead sweating. During attacks, there is increased intraocular pressure on the symptomatic side and swelling of the eyelids. No changes in pupil diameter have been observed. Attacks can be triggered mostly from trigeminally innervated areas, but also from the extratrigeminal territory. There are also spontaneous attacks. An irregular temporal pattern is the rule, with symptomatic periods alternating with remissions in an unpredictable fashion. During active periods, the frequency of attacks may vary from &lt;1 attack/day to&gt;30 attacks/hour. The attacks predominate during the daytime, nocturnal attacks being seldom reported. A SUNCT‐like picture has been described in some patients with either intra‐axial or extra‐axial posterior fossa lesions, mostly vascular disturbances/ malformations. In the vast majority of patients, however, aetiology and pathogenesis are unknown. In SUNCT syndrome, there is a lack of persistent, convincingly beneficial effect of drugs or anaesthetic blockades that are generally effective in cluster headache, chronic paroxysmal hemicrania, trigeminal neuralgia, idiopathic stabbing headache (Äjabs and jolts syndrome'), and other headaches more faintly resembling SUNCT syndrome. Single reports have claimed that carbamazepine, lamotrigine, gabapentin, corticosteroids or surgical procedures may be of help. However, caution is recommended when assessing any therapy in a disorder such as SUNCT syndrome, in which the rather chaotic and unpredictable temporal pattern makes the assessment of any drug/therapeutic effect per se a particularly difficult matter.Comment: Another excellent review article. If you want to learn about the rare, short trigeminal autonomic cephalgia (TAC), this is a thorough and thoughtful place to start. SJT

Idiopathic stabbing headache in the juvenile population: a clinical study and review of the literature

Idiopathic stabbing headache is a not well known type of pain, and few reports have described the disorder in juvenile age. We report a sample of 30 juvenile patients with clinical features of stabbing headache after having excluded other pain disorders. We observed the presence of psychological features and the lack of association with migraine, unlike in the adult form. Some patients needed pharmacological treatment but the prognosis was good. Further studies are needed to better understand the mechanisms of pain and possible triggering factors.

Episodic parieto-occipital idiopathic stabbing headache-like pain: a case report

We describe a patient with a variant of idiopathic stabbing headache (ISH). This case differs from ISH by its temporal profile (status-like), its region (extratrigeminal), its lack of association with other types of headache, and the episodic form of pain attacks.

SUNCT Syndrome: diagnosis and treatment.

Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing (SUNCT) is a syndrome predominant in males, with a mean age of onset around 50 years. The attacks are strictly unilateral, generally with the pain persistently confined to the ocular/periocular area. Most attacks are moderate to severe in intensity and burning, stabbing or electrical in character. The mean duration of paroxysms is 1 minute, with a usual range of 10 to 120 seconds (total range 5 to 250 seconds). Prominent, ipsilateral conjunctival injection and lacrimation regularly accompany the attacks. Nasal stuffiness/rhinorrhoea are frequently noted. In addition, there is subclinical forehead sweating. During attacks, there is increased intraocular pressure on the symptomatic side and swelling of the eyelids. No changes in pupil diameter have been observed. Attacks can be triggered mostly from trigeminally innervated areas, but also from the extratrigeminal territory. There are also spontaneous attacks. An irregular temporal pattern is the rule, with symptomatic periods alternating with remissions in an unpredictable fashion. During active periods, the frequency of attacks may vary from <1 attack/day to >30 attacks/hour. The attacks predominate during the daytime, nocturnal attacks being seldom reported. A SUNCT-like picture has been described in some patients with either intra-axial or extra-axial posterior fossa lesions, mostly vascular disturbances/ malformations. In the vast majority of patients, however, aetiology and pathogenesis are unknown. In SUNCT syndrome, there is a lack of persistent, convincingly beneficial effect of drugs or anaesthetic blockades that are generally effective in cluster headache, chronic paroxysmal hemicrania, trigeminal neuralgia, idiopathic stabbing headache ('jabs and jolts syndrome'), and other headaches more faintly resembling SUNCT syndrome. Single reports have claimed that carbamazepine, lamotrigine, gabapentin, corticosteroids or surgical procedures may be of help. However, caution is recommended when assessing any therapy in a disorder such as SUNCT syndrome, in which the rather chaotic and unpredictable temporal pattern makes the assessment of any drug/therapeutic effect per se a particularly difficult matter.