ICD-10 CODE R51
Clinical Syndrome
Ice pick headache is a constellation of symptoms consisting of paroxysms of stabbing jabs and jolts that occur primarily in the first division of the trigeminal nerve. These paroxysms of pain may occur as a single jab or a series of jabs that lasts for a fraction of a second followed by relatively pain-free episodes. The pain of ice pick headache occurs in irregular intervals of hours to days. Similar to cluster headache, ice pick headache is an episodic disorder that is characterized by clusters of painful attacks followed by pain-free periods. Episodes of ice pick headache usually occur on the same side, but in rare patients the pain may move to the same anatomical region on the contralateral side. Ice pick headache occurs more commonly in women and is generally not seen before the fourth decade of life, but rare reports of children suffering from ice pick headache sporadically appear in the literature. Synonyms for ice pick headache include jabs and jolts headache, primary stabbing headache, ophthalmodynia periodica, and idiopathic stabbing headache.
Signs and Symptoms
A patient suffering from ice pick headache complains of jolts or jabs of pain in the orbit, temple, or parietal region ( Fig. 1.1 ). Some patients describe the pain of ice pick headache as a sudden smack or slap on the side of the head. Similar to patients suffering from trigeminal neuralgia, a patient suffering from ice pick headache may exhibit involuntary muscle spasms of the affected area in response to the paroxysms of pain. In contrast to trigeminal neuralgia, involving the first division of the trigeminal nerve, there are no trigger areas that induce the pain of ice pick headache. The neurological examination of a patient suffering from ice pick headache is normal. Some patients exhibit anxiety and depression because the intensity of pain associated with ice pick headache leads many patients to believe they have a brain tumor.
Testing
Magnetic resonance imaging (MRI) of the brain provides the best information regarding the cranial vault and its contents. MRI is highly accurate and helps to identify abnormalities that may put the patient at risk for neurological disasters secondary to intracranial and brainstem pathological conditions, including tumors and demyelinating disease ( Fig. 1.2 ). Magnetic resonance angiography (MRA) also may be useful in helping identify aneurysms, which may be responsible for the patient’s neurological findings. In patients who cannot undergo MRI, such as a patient with a pacemaker, computed tomography (CT) is a reasonable second choice. Radionuclide bone scanning and plain radiography are indicated if fracture or bony abnormality, such as metastatic disease, is considered in the differential diagnosis.
