4.1: Idiopathic stabbing headache

This condition is also known as icepick headache. In 1981, Medina and Diamond described headache syndrome with three main features: (1) lateralized continuous, dull aching pain; (2) superimposed daily recurring jabbing, icepick-like head pain that was often provoked by physical exertion; and (3) focal lateralized intense pain, often throbbing, lasting 5 to 50 minutes. This focal pain recurred multiple times during the day tending to waken people from sleep and was triggered by alcohol and physical exertion in half the 54 patients described. The intense focal pain element, according to Raskin (1988), was often associated with photosensitivity and nausea. Headaches could occur at any age with equal representation among men and women. It was found that most patients were responsive to indomethacin, a non-steroidal anti-inflammatory drug.

Boghen and Desaulniers (1983) reported a man with lateralized continuous head pain of twenty years duration. Superimposed upon the continuous pain were icepick jabs occurring up to five times per day. Methysergide, propranolol, and ergotamine were ineffectual, but indomethacin 50 mg per day rendered the patient pain free. The term hemicrania continua was provided by Sjaastad and Spierings (1984) in their description of two patients. Both of the patients had lateralized head pain with one having superimposed jabbing with icepick pain. One of them also had an episodically reddened eye on the side of the pain. Both were aspirin- and indomethacin-responsive while failing to have any benefit from naproxen, ibuprofen, and piroxicam.

Such observations separated a number of patients previously believed to have "tension" headache who could be successfully treated with indomethacin. The drug was later employed in migraine by Sicuteri et al (1964, 1965) and Anthony and Lance (1968).

Raskin (1988) reported a number of patients, previously troubled by episodic hemicranial pain with florid migrainous features who entered a phase in which continuous lateralized pain was the presenting complaint and who were rendered completely pain-free by indomethacin. Raskin (1986) reported icepick headache pain occurs in over 40% of migraineurs and found them to be "remarkably responsive to indomethacin." He regarded this syndrome as a variation of migraine.



 

 

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