Stabbing facial pain reminiscent of primary stabbing headache

Primary stabbing headache (PSH) is a transient and localized headache disorder. Facial variants of this rare pain syndrome have not been previously described. Four patients (n = 2 female, 2 male) presented themselves to our headache and facial pain outpatient clinic. They suffered daily from several dozen to several hundred short-lasting stabbing pain paroxysms primarily in the second and third trigeminal branches (V2 and V3) without lateral predominance. These non-neuralgic pain paroxysms did not strictly follow dermatomes, were not accompanied by trigeminal autonomic features and could not be triggered but occurred exclusively spontaneously. They did not fulfill any existing ICHD-3 criteria but appeared clinically to have similarities to primary stabbing headache syndromes. Indomethacin showed no efficacy. Exclusive facial variants of stabbing pain paroxysms should be classified as separate entities and tentatively be called stabbing facial pain.

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Paroxysmal Stabbing Headache in The Multiple Dermatomes of The Head and Neck: A Variant of Primary Stabbing Headache or Occipital Neuralgia?

Cephalalgia ◽

10.1111/j.1468-2982.2007.01395.x ◽

2007 ◽

Vol 27 (10) ◽

pp. 1101-1108 ◽

Cited By ~ 10

Author(s):

JH Shin ◽

HK Song ◽

JH Lee ◽

WK Kim ◽

MK Chu

Keyword(s):

Medical Center ◽

Previous History ◽

Headache Disorder ◽

Acute Onset ◽

Occipital Neuralgia ◽

Cervical Nerve ◽

Primary Stabbing Headache ◽

History Of ◽

Stabbing Headache

A paroxysmal stabbing or icepick-like headache in the multiple nerve dermatomes, especially involving both trigeminal and cervical nerves, has not been fully explained or classified by the International Classification of Headache Disorder, 2nd Edition (ICHD-II). Of patients with acute-onset paroxysmal stabbing headache who had visited the Hallym University Medical Center during the last four years, 28 subjects with a repeated stabbing headache involving multiple dermatomes at the initial presentation or during the course were prospectively enrolled. All patients were neurologically and otologically symptom free. A coincidental involvement of both trigeminal and cervical nerve dermatomes included seven cases. Six cases involved initially the trigeminal and then cervical nerve dermatomes. Five cases showed an involvement of the cervical and then trigeminal nerve dermatomes. The remaining patients involved multiple cervical nerve branches (the lesser occipital, greater occipital and greater auricular). Pain lasted very shortly and a previous history of headache with the same nature was reported in 13 cases. Preceding symptom of an infection and physical and/or mental stress were manifested in seven and six subjects, respectively. All patients showed a self-limited benign course and completely recovered within a few hours to 30 days. Interestingly, a seasonal gradient in occurrence of a stabbing headache was found in this study. A paroxysmal stabbing headache manifested on multiple dermatomes can be explained by the characteristics of pain referral, and may be considered to be a variant of primary stabbing headache or occipital neuralgia.

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Primary stabbing headache

Oxford Textbook of Headache Syndromes ◽

10.1093/med/9780198724322.003.0023 ◽

2020 ◽

pp. 215-219

Author(s):

Rashmi B. Halker ◽

Esma Dilli ◽

Amaal Starling

Keyword(s):

Treatment Options ◽

Headache Disorder ◽

Primary Stabbing Headache ◽

Drug Of Choice ◽

Prophylactic Drug ◽

Stabbing Headache ◽

Idiopathic Stabbing Headache ◽

The Brain ◽

Cyclooxygenase 2 Inhibitors ◽

Secondary Causes

Primary stabbing headache is a unique headache disorder, also known as idiopathic stabbing headache, ice pick headache, and jabs and jolts syndrome. The headache is described as a sharp, stabbing pain, lasting seconds to minutes, with no associated symptoms, including any autonomic features. It is more common in women by a 3:1 ratio and is comorbid with migraine, with some studies reporting that up to 40% of migraineurs also have primary stabbing headache. Performing magnetic resonance imaging of the brain is reasonable in patients who present with stabbing headache, as there are secondary causes. Meningiomas, hemorrhages, and giant cell arteritis have all been reported to present in this manner. As primary stabbing headache is a benign disorder, infrequent attacks do not require treatment and patients can be counselled accordingly. For more frequent attacks, indomethacin is the prophylactic drug of choice. Other treatment options include melatonin and cyclooxygenase-2 inhibitors.

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Primary Stabbing Headache in A Headache Clinic

Cephalalgia ◽

10.1111/j.1468-2982.2007.01365.x ◽

2007 ◽

Vol 27 (9) ◽

pp. 1005-1009 ◽

Cited By ~ 31

Author(s):

J-L Fuh ◽

K-H Kuo ◽

S-J Wang

Keyword(s):

Trigeminal Nerve ◽

Headache Disorder ◽

Headache Disorders ◽

Body Movements ◽

Primary Stabbing Headache ◽

Fixed Area ◽

Stabbing Headache ◽

Accompanying Symptoms ◽

Headache Clinic

Primary stabbing headache (PSH) is a short-lasting but troublesome headache disorder which has been known for several decades. We surveyed and registered consecutive patients with PSH in a headache clinic in Taiwan. A total of 80 patients (24 M/56 F, 53.2 ± 16.2 years) were enrolled in our study. Migraine was reported in 20 (25%) patients and was less common in those with PSH onset at >50 years than those with onset at <50 years (14% vs. 38%, P = 0.02). The headache was unilateral in 59% of the patients and always in a fixed area in 36%. The head pain frequently involved extratrigeminal regions (70%) and in 30 patients (38%) was accompanied by jolts, i.e. head or body movements. Indomethacin was effective (74%) in patients who received it. Our study showed primary stabbing headache was a common and easily treated headache disorder in headache clinic. However, 70% of our patients could not fulfil criterion A ‘exclusively or predominantly in the distribution of the first division of the trigeminal nerve’ and 15% could not fulfil criterion C ‘no accompanying symptoms’ of the International Classification of Headache Disorders-II criteria proposed for PSH.

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Characteristics of Primary Stabbing Headache in a Tertiary Neurological Clinic in China

Pain Medicine ◽

10.1111/pme.12361 ◽

2014 ◽

Vol 15 (5) ◽

pp. 871-875 ◽

Cited By ~ 4

Author(s):

Xiping Liang ◽

Guomin Ying ◽

Qingqing Huang ◽

Jing Wang ◽

Nan Li ◽

...

Keyword(s):

Primary Stabbing Headache ◽

Stabbing Headache

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Micturition-triggered severe headache associated with bladder paraganglioma: A case report

Cephalalgia ◽

10.1177/03331024211036155 ◽

2021 ◽

pp. 033310242110361

Author(s):

Yonghui Liu ◽

Tianlu Wei

Keyword(s):

Case Report ◽

Neuroendocrine Tumors ◽

Pain Syndrome ◽

Signs And Symptoms ◽

Headache Disorder ◽

Severe Headache ◽

Case Description ◽

Middle Aged ◽

Aged Woman ◽

Middle Aged Woman

Background Paragangliomas are rare neuroendocrine tumors, especially in the bladder. Although many paragangliomas are non-functional, functioning paragangliomas present with many non-specific signs and symptoms, such as hypertension and headache, complicating their diagnosis. Here, we report a case of micturition-induced severe headache associated with a bladder paraganglioma. Case description: This report describes a severe headache disorder triggered by micturition and associated with a bladder paraganglioma in a middle-aged woman. Her pain occurred consistently after micturition, beginning from the left side of the nose and gradually extended to the forehead and the parietal and occipital regions. The headaches lasted 5–10 min. Removal of the paraganglioma completely eliminated the patient’s pain syndrome. Conclusion This case elucidates the association between micturition-triggered headaches and bladder paragangliomas. The presence of a post-micturition severe headache should suggest the possibility of a bladder paraganglioma.

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