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.

Primary stabbing headache

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.

Prophylaxis with melatonin for primary stabbing headache in pediatrics: a case report

Introduction: Primary stabbing headache (or “ice pick headache”) is an alteration characterized by brief jabs (short stabs of pain, lasting ~3 seconds), which appear spontaneously, irregularly, and affecting unilaterally or bilaterally. Indomethacin has traditionally been used as the main therapeutic option. However, this drug is ineffective in a considerable percentage of patients and can generate multiple adverse effects that occur at therapeutic doses. Clinical case: A 7-year-old male patient with primary stabbing headache of mild to moderate intensity, lasting 3 to 4 seconds, without relevant history, with normal neurodevelopment, neurological examination and neuroimaging; no triggers were identified. It was started therapeutic trial with Coenzyme Q10; however, no improvement in the symptoms was identified. Treatment and outcomes: A therapeutic management was carried out with Melatonin, which led to complete remission of the symptoms; without adverse effects in the posterior follow-up months. Clinical and scientific relevance: There is little information regarding effective and safe treatments for primary stabbing headache in children. The present case identifies Melatonin as an innovative, effective and safe therapeutic alternative in the treatment of primary stabbing headache in children. This is a significant advance in the understanding of primary stabbing headache in the pediatric population. Conclusion: Melatonin may be an effective and safe therapeutic option for the treatment of primary stabbing headache in pediatric patients. It is necessary to deepen its research, in order to establish its use in a clinical practice guide.