Ice Pick Headaches and a Link to Autoimmune Disease

Ice pick headaches, known officially as primary stabbing headaches, cause sharp, stabbing pain that comes and goes. It's classified as a chronic primary headache disorder, meaning the stabbing head pains are not caused by an underlying medical condition. In other words, this type of headache exists on its own without another health explanation.

This article will take you through the symptoms, causes, and treatment of ice pick headaches as well as their association with autoimmune diseases. Other types of headaches and health issues ice pick headaches may be mistaken for are also explored.

What Are the Symptoms of an Ice Pick Headache?

Symptoms of ice pick headaches include the following:

• A single stab or series of stabbing pains occur in the head (like "ice-pick pains" or "jabs and jolts").
• Short-acting, these typically last three seconds or less.
• Stabs appear irregularly, occurring once to a few times a day (although it can occur up to 50 or even 100 times a day).
• Stabs may occur repetitively over days, but this is rare.

Ice Pick Headaches vs. Cluster Headaches

Like ice pick headaches, cluster headaches are also excruciatingly painful and typically localized in or around the eye or temple area. However, cluster headaches tend to build gradually in intensity. Attacks last anywhere from 15 to 180 minutes, can be felt up to eight times a day, and occur in “clusters” from two weeks to three months.

Cluster headaches also differ from ice pick headaches in that they are accompanied by at least one cranial autonomic symptom (e.g., eye tearing, runny nose, facial flushing, or upper eyelid drooping). 

Can Ice Pick Headaches Be a Sign of an Aneurysm?

An aneurysm occurs when a part of a blood vessel wall weakens, causing an abnormal swelling or bulge. Aneurysms can develop in several parts of the body including the brain. Brain aneurysms are common and usually don't cause symptoms or health issues unless they rupture.

A ruptured aneurysm in the brain can cause subarachnoid hemorrhages or hemorrhagic strokes. The headache experienced is often termed "the worst headache of my life" by stroke sufferers and typically differs markedly—in intensity, location, and duration—from the short bursts of pain described with ice pick headaches.

When to Seek Medical Attention for a Headache

Seek medical treatment immediately if experiencing any of the following symptoms:

• Thunderclap headache (extreme, explosive head pain peaking within one minute and lasting at least five minutes) or other severe headache pain
• Seizures
• Paralysis or other stroke symptoms
• Numbness or weakness on one side of the face or body
  
• Loss of consciousness
• Confusion or changes in speech or thinking
• Vision changes, peripheral vision loss, double vision
• A droopy eyelid on one side
• Changes in the size of one pupil
  

What Are the Causes of an Ice Pick Headache?

Experts believe that the origin of this headache stems from irritation of trigeminal nerve endings. This is because the pain of this headache disorder is felt in the distribution of the first branch of the trigeminal nerve (around the eye, temple, and side of the head).

However, ice pick headache is a distinct condition from another pain-related disorder called trigeminal neuralgia.

How Is an Ice Pick Headache Diagnosed?

An ice pick headache can be tricky to diagnose, as it can coexist, and even occur simultaneously, with other headache disorders like migraines or cluster headaches.

In addition to a thorough history and neurological examination, healthcare providers may perform brain scans like magnetic resonance imaging (MRI) to rule out worrisome conditions before confirming a diagnosis.

How Is an Ice Pick Headache Treated?

Treatment of ice pick headaches may entail taking Tivorbex (indomethacin), which is a non-steroidal anti-inflammatory medication (NSAID). However, indomethacin may not work for up to one-third of people and may cause kidney or gastrointestinal side effects.

Other potential medications a healthcare provider may prescribe for ice pick headaches include:

• Celebrex (celecoxib) (a COX-2 inhibitor)
• Neurontin (gabapentin)
• Melatonin

Can Autoimmune Disorders Cause Ice Pick Headaches?

Science suggests that, in some people, autoimmune disease and ice pick headaches are related. An autoimmune disease is a condition characterized by your immune system attacking normal, healthy organs. For example, in multiple sclerosis, immune cells attack nerve coverings in the brain and spinal cord.

One Italian study in Clinical Neurology and Neurosurgery examined 26 people with a diagnosis of ice pick headache. The researchers found that of these 26 people, 14 had an autoimmune disease.

In addition, seven of those 14 people had evidence of myelin loss (called demyelination) on an MRI. Those with evidence of demyelination included people with a diagnosis of MS, Sjögren's syndrome, or vasculitis.

The other seven people with both ice pick headaches and an autoimmune disease did not have evidence of demyelination on their MRI. These people had the following autoimmune conditions:

• Systemic lupus erythematosus
• Behcet's disease
• Antiphospholipid antibody syndrome
• Vasculitis
• Clinically isolated syndrome (the first episode of multiple sclerosis)
• Lyme disease (not classified as autoimmune but possibly related to autoimmunity)

The precise mechanism behind how these conditions trigger stabbing headaches is unclear, but based on the demyelination findings in some participants, authors hypothesize that a demyelinating injury of an area in the brain may be responsible.

What about the other seven who did not have demyelinating findings? It's hard to say, but the authors suggest it's possible the demyelination simply could not yet be detected on MRI.

A 2013 case study (a report on an individual patient), also found an association between ice pick headaches and MS. It involved a young woman who had episodes of stabbing headaches up to 100 times a day.

During one episode, the stabbing head pains were associated with numbness and tingling of her right arm. Her headaches and neurological symptoms resolved with steroids, which are used to treat relapses in multiple sclerosis.

Remember, an association does not imply causation. Just because you have stabbing headaches does not mean you also have an autoimmune condition and vice versa. This is simply an interesting link and warrants more research to better understand the "why" behind it.

That being said, this connection may alter how your healthcare provider treats your stabbing headaches. For instance, they may consider steroids to calm down your stabbing head pain if you also have an autoimmune condition.

Summary

When it comes to ice pick headaches, the good news is that most people don't experience persistent symptoms. Although there is an association between this type of headache and autoimmune disease, experiencing ice pick headaches does not mean you have an autoimmune disease. There are several treatment options for repeat sufferers including NSAIDs and melatonin. Always seek medical attention for severe head pain accompanied by stroke symptoms, such as vision changes or paralysis.