Primary Stabbing Headache: “Sticking Out the Pain”

Abstract Primary stabbing headache, previously referred to as “ice-pick headache,” is a headache condition that causes short-lived but excruciating pain in the extratrigeminal regions. It is diagnosed through careful patient examination as well as testing to rule out conditions with similar presentation: clinicians should not discredit the importance of a detailed patient history while caring for individuals suffering from headaches. When primary stabbing headache is suspected, clinicians must exclude giant cell arteritis, glaucoma, cluster headache, thunderclap headache, and reversible cerebral vasoconstriction syndrome. Once diagnosis of primary stabbing headache has been established, possible treatment options include long-acting NSAIDs, gabapentin, and botox injections. The aim of this case review is to guide the reader through a complex case study in which a clinician is faced with the challenge of navigating both patient history and diagnostic testing to establish the most appropriate headache diagnosis.