Ice Pick Headache: Causes, When to Worry, Treatment

Ice Pick Headache — Causes, When to Worry and Treatment

Sudden, sharp stabs of pain that come and go in seconds: what causes them, the warning signs that need urgent care, and what helps. Explained by a Sydney neurologist.

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When a Stabbing Pain in the Head Needs Urgent Care

Most sudden stabs of pain in the head are not dangerous. A few patterns need care straight away, so they come first.

Call 000 — or go to an emergency department — if

a headache comes on suddenly and severely, reaches its worst within a minute and does not go away within seconds (the worst headache of your life), even if it later eases
the headache comes with fever and a stiff neck, a rash that does not fade when pressed, confusion or unusual drowsiness
you are over 50 with a new headache and you notice blurring, double vision, or sight that dims or goes dark in one eye, even if it lasts only a few minutes
the headache or stabs come with sudden loss or dimming of vision (even if brief), double vision, a new drooping eyelid or one pupil larger than the other, slurred speech, sudden severe dizziness or unsteadiness, or numbness, weakness or drooping of the face, an arm or a leg
an eye becomes painful and red, with blurred vision, halos (coloured rings) around lights, or nausea and vomiting
the headache started after a head injury and is getting worse, comes with vomiting, drowsiness or confusion, or you take blood-thinning medicine
the headache comes with a seizure

A sudden, explosive headache, wherever it is felt, can mean bleeding around the brain (a subarachnoid haemorrhage): it reaches its worst within a minute and lasts, unlike an ice pick stab, which is usually over within seconds and leaves no headache behind. In someone over 50, a new headache with a change in vision can mean giant cell arteritis is cutting off the blood supply to the eye (see below): treated the same day, sight can usually be saved, but sight that is lost rarely comes back. Weakness, numbness or drooping of the face, trouble speaking, sudden unsteadiness or a sudden loss of vision can mean a stroke. Double vision, a new drooping eyelid or a change in the size of one pupil can mean pressure on a nerve from a bulging blood vessel (an aneurysm) or a tear in the wall of an artery in the neck (a dissection). A painful red eye with blurred vision and halos can mean a sudden rise in the pressure inside the eye (acute angle-closure glaucoma), which can permanently damage sight if it is not treated quickly. After a head injury, bleeding inside the skull can build up over hours, sometimes after a spell of feeling well. Fever with a stiff neck, or a rash that does not fade when pressed, can mean meningitis. A seizure with a headache needs urgent checks for a cause in the brain. All need urgent treatment. If a doctor has confirmed you have ice pick headaches, a stab like your usual ones, usually over within seconds and with nothing else wrong, does not need 000. Your usual migraine aura (shimmering or zigzag lines that spread slowly over several minutes and clear within an hour), or the eye signs of attacks a doctor has already diagnosed as cluster headache or SUNCT, do not need 000 either; a first attack, or one that is different, needs urgent care. Remember FAST: Face drooping, Arm weakness, Speech difficulty, Time to call 000.

See your GP the same day if

it is a new headache and you are over 50, especially with a new tender scalp that does not go away, pain in the jaw when you chew that eases when you stop, aching shoulders, or feeling generally unwell; with any change in your vision, see the list above
a rash of small blisters appears on one side of the forehead, scalp or face, often after 2 or 3 days of burning, tingling or stabbing pain there; if it reaches the tip of the nose, or the eye becomes red, painful or blurred, go to an emergency department the same day
the headache is getting steadily worse over days or weeks, or is worst on waking or when lying down, with vomiting or blurred vision
the stabs or the headache are brought on by coughing, sneezing, laughing or straining, or come with a whooshing sound in the ears in time with your heartbeat
you have a fever with the headache
you have cancer or a weakened immune system
you are pregnant or have had a baby in the last few weeks; with blurred vision or sudden swelling of the face or hands, contact your maternity unit or go to hospital now

Fever can mean an infection. Cancer, a weakened immune system, and pregnancy or a recent birth each make some serious causes more likely, such as high blood pressure of pregnancy (pre-eclampsia), so the bar for checking is lower. The other items are explained further down this page. Stabs that are new, frequent, or always in exactly the same spot are not an emergency, but see your GP about them. If you cannot see your GP that day, go to an emergency department. If something matches both lists, follow the 000 list.

Where most people sit

These patterns are uncommon. Most sudden, sharp stabs that are gone within seconds are ice pick headache: about 1 in 3 adults have had them, and typical ice pick headache, once a doctor has confirmed it, is not a sign of a burst blood vessel, a stroke or a tumour. If you are worried about a brain tumour: in a large UK study of family-doctor records, fewer than 1 in 1,000 people who saw their GP with a headache were later found to have one, and tumours usually cause other symptoms too, such as weakness, seizures, a change in personality, or a headache that gets steadily worse over weeks.

If Something Were Wrong There, Why Would the Pain Move?

You are in the middle of a sentence when a sharp stab hits just above your left eye. You wince, perhaps say "ow", and before your hand reaches your forehead it is gone. An hour later another one strikes behind your right ear. A pain that sharp feels like a warning: a blood vessel about to burst, or something growing in that spot. But if something were damaged there, why would the pain be gone in a second or two? And why would the next stab strike somewhere else?

Doctors call these stabs primary stabbing headache; older names include ice-pick pains, jabs and jolts, and needle-in-the-eye syndrome. "Primary" means the stabs are the condition itself, not a sign of disease at the spot where they are felt. In about 2 in 3 people the stabs move from place to place, sometimes switching sides, and that is part of the answer: pain from damage at one spot usually stays at that spot. Each stab is real pain, carried by the same nerves as any other pain in the head, but it does not come from an injury where you feel it.

So what sets it off? No one knows for certain, but there is a strong clue in who gets the stabs. In a US study, 42 of 100 people with migraine had had them, compared with 3 of 100 people without migraine, and in people with migraine the stabs often strike where the migraine usually hurts. At a London hospital headache centre that sees referred patients, 9 in 10 of the 68 people diagnosed with stabbing headache also had migraine. This has led researchers to suggest that the stabs share some of migraine's biology, in which the pain pathways of the head are more easily set off. On this view a stab is a brief false alarm in those pathways, a bit like a smoke alarm that chirps once and falls silent, rather than a sign of fire.

Where most people sit

Ice pick headaches are common and brief. In a Norwegian study of 1,838 adults, about 1 in 3 had had them, and most had had only a few. Once a doctor has confirmed that the pattern is typical, they are harmless: they do not damage the brain, and they often come in spells that settle by themselves.

What an Ice Pick Headache Feels Like

Each of these features is typical. No single one proves it, but together they make the pattern.

The stab. A sudden, sharp, stabbing or jabbing pain, like being poked with an ice pick or a needle, as a single stab or a short series of stabs.
How long. A second or two: in studies, 80% of stabs last 3 seconds or less. Rarely, one lasts up to 2 minutes.
How often. Usually one or a few a day, with long gaps in between. In the Norwegian study, most people had had only a few stabs, and about two-thirds had only ever had single stabs rather than a series. Rarely, the stabs come in runs, many a day for several days.
Where. Anywhere on the head: the temple, around or behind an eye, the top of the head or the back of it. Usually on one side at a time, though the side can switch. In about 2 in 3 people the stabs move from spot to spot; in the other third they keep returning to one place.
How strong. Usually mild to moderate, though some stabs are severe enough to stop you mid-sentence.
The flinch. Many people jerk their head or flinch as a stab hits (in a Taiwanese headache clinic, almost 4 in 10 did), and a few cry out.
What brings them on. Most come out of the blue. In the Norwegian study, a sudden neck movement or straining occasionally seemed to set one off. Even so, stabs or a headache set off by coughing, sneezing or straining need your GP the same day, because they can be a different condition, explained below.
Nothing else. No red or watering eye, no blocked or runny nose, and no numbness; a few people feel brief nausea or a dislike of light. In people with migraine, stabs can come on their own or during a migraine attack.
Who gets them. People of any age, from young children to old age; more women than men; and especially people with migraine. Among people seen in headache clinics, the stabs had started at about 42 on average, and on average about 5 years passed before anyone put a name to them.

Ice Pick Headache, Trigeminal Neuralgia, Occipital Neuralgia, SUNCT or Brain Freeze?

Five conditions cause brief, sharp pains in the head. These features help tell them apart.

Swipe the table sideways to compare all five →

Feature	Ice pick headache	Trigeminal neuralgia	Occipital neuralgia	SUNCT and SUNA	Brain freeze
Where it hurts	Anywhere on the head; often moves from spot to spot, and can switch sides	One side of the face: the cheek, jaw, teeth, gums or lips, or around the eye and forehead	The back of the head, on one or both sides, running up from the base of the skull; it can reach the top of the head or behind the eye	Always one side: around or above the eye, or the temple	The forehead or temples, usually both sides
Feels like	A sudden, sharp stab; usually mild to moderate	Severe electric shocks, shooting or stabbing	Severe shooting or stabbing pains	Moderate or severe single stabs, a series of stabs, or a saw-tooth pattern	A sharp pain that can be intense
How long	A second or two; usually one or a few a day	A fraction of a second to 2 minutes, often many times a day	A few seconds to minutes, in repeated attacks	1 second to 10 minutes, at least once a day and often many times	Seconds, and gone within 10 minutes of the cold stopping
Brought on by	Usually nothing; occasionally a sudden head movement	Light touch, eating, talking, brushing the teeth, washing or shaving the face, or a breeze	Often nothing; touching the scalp or brushing the hair can be painful	Often touching the face, as well as coming on their own	Ice cream, crushed-ice drinks or very cold air touching the roof of the mouth or the back of the throat
Other symptoms	Usually none; a flinch; more common with migraine	Usually none between attacks, though a dull ache can linger in some people	A numb, tingly or sore scalp; a tender spot at the base of the skull	On the same side: a red, watering eye, a blocked or runny nostril, a drooping or swollen eyelid, sweating or flushing	None; more common in people with migraine

Ice cream or ice pick? The names are easily confused. Brain freeze (doctors call it cold-stimulus headache) comes on straight after something very cold touches the roof of the mouth or the back of the throat, and it is gone within 10 minutes of the cold stopping. It is common and harmless, and more common in people with migraine. It is most likely with crushed-ice drinks taken quickly, though even ice cream eaten slowly can set it off.

Where most people sit

The table is a guide, not a diagnosis. Ice pick headache and brain freeze are common, and once they are recognised, harmless. Trigeminal neuralgia and occipital neuralgia are much less common, and SUNCT and SUNA are rare. Each has its own treatment, which is why telling them apart is the main job of the consultation.

When Stabbing Pains Have Another Cause

Ice pick headache is diagnosed once other causes have been thought about. In a Korean study of 245 people who came to a hospital clinic with stabbing head pains and no obvious cause, 9 turned out to have another cause within two weeks: 7 had shingles and 2 had Bell's palsy. These are the conditions doctors look for.

Shingles. Burning, tingling or stabbing pain on one side of the forehead, scalp or face, followed after 2 or 3 days by a rash of small blisters there. Treatment works best when it is started early, so see your GP the same day. If the rash reaches the tip of the nose, or the eye becomes red, painful or blurred, go to an emergency department the same day, because shingles can affect the eye.
Bell's palsy. A weakness of one side of the face, from inflammation of the nerve that moves it, which can begin with pain behind the ear. Most people recover over weeks to months. Weakness or drooping of the face needs 000, because only a doctor can tell it apart from a stroke.
Trigeminal neuralgia. Severe, electric-shock-like stabs in one side of the face, lasting from a fraction of a second to 2 minutes, set off by light touch, eating, talking or brushing the teeth. Read more about trigeminal neuralgia.
Occipital neuralgia. Shooting or stabbing pains that run from the base of the skull up over the back of the head, lasting seconds to minutes, often with a numb, tingly or sore scalp and a tender spot at the base of the skull. Unlike ice pick stabs, which often jump from spot to spot, these follow the path of the nerve. See headache at the back of the head.
Short one-sided attacks with a red, watering eye (SUNCT and SUNA). Stabbing pain around one eye or temple, lasting from 1 second to 10 minutes, at least once a day and often many times, with a red, watering eye, a blocked or runny nostril, or a drooping or swollen eyelid on the same side; touching the face can set them off. They are rare and need a neurologist's diagnosis, usually with an MRI scan. Cluster headache has similar eye signs (a red, watering eye, a drooping eyelid or a smaller pupil) but lasts 15 minutes to 3 hours: see cluster headache. The eye signs settle after each attack; a first attack like this, or one that is different from your usual attacks, needs same-day assessment in an emergency department. A painful red eye with blurred vision or halos is different: see the list at the top.
Giant cell arteritis. After 50, a new headache with a tender scalp (the scalp can also feel tender during a migraine attack; in giant cell arteritis the tenderness is new and does not go away), pain in the jaw muscles when you chew, aching shoulders or feeling generally unwell can be giant cell arteritis, an inflammation of the arteries of the head. It needs your GP the same day for blood tests, because it can affect the eyesight: if your sight blurs, doubles or dims, go to an emergency department now.
A coin-shaped patch. Pain in one small, sharply outlined patch of scalp, round or oval and 1 to 6 cm across, that stays the same size and shape, usually on the upper part of the side of the head, is nummular headache. It is often long-lasting, constant or coming and going, and the skin there can feel numb, tingly or tender. A doctor checks the skin and the skull underneath first.
A growth or other change in the brain. Rarely, stabbing pains are the first sign of something else. A few case reports describe a meningioma (a growth of the coverings of the brain, usually not cancer) found in people whose stabs stopped once it was removed, and stabbing pains have also been described with multiple sclerosis and stroke. This is why stabs that are always in exactly the same spot, or that come with other symptoms such as numbness, weakness or a change in your vision, should be checked.
Raised pressure inside the head. A headache that is worse lying down or first thing in the morning, sometimes with vomiting or blurred vision, and that gets steadily worse, can mean pressure is building up, for example from a blockage of the fluid pathways or, rarely, a tumour. Raised pressure of the fluid around the brain without a tumour (idiopathic intracranial hypertension) can also cause a whooshing sound in the ears in time with the heartbeat, and is most common in women of child-bearing age. All need prompt assessment, because some can affect sight.

Stabs or a headache set off within a second or two of coughing, sneezing, laughing or straining are a different condition (cough headache). The pain peaks almost at once and usually fades over seconds to minutes. About 4 in 10 cough headaches have an underlying cause, most often a Chiari malformation, where the lowest part of the brain sits lower than usual and crowds the top of the spinal canal. So a cough headache is always worth having checked, usually with an MRI scan. Headaches that come on with hard exercise or during sex are assessed with the same care: see headache after exercise.

Where most people sit

These causes are uncommon. In the Korean study, 236 of the 245 people, more than 9 in 10, met the criteria for ice pick headache, with no other cause found in two weeks, and most of the rest had shingles, which declared itself with a rash within two weeks. A careful history and examination usually tell a doctor whether another cause is possible, and the right test, when one is needed, usually answers the question.

How Is Ice Pick Headache Diagnosed?

There is no test for ice pick headache: it is diagnosed from your story and an examination. Tests are for when the pattern raises a question.

Your story. How long each stab lasts, where it strikes and whether it moves, how often it comes, what sets it off (touch, chewing, coughing, a cold drink), whether the eye reddens or waters, any numbness or constant ache, any rash, and any other headaches, especially migraine.
The examination. A full neurological examination, including the back of the eyes, feeling in the face and scalp, the nerves at the base of the skull, and the skin of the scalp and face.
A scan, when it will change what happens next. An MRI scan may be advisable when the stabs are always in exactly the same spot, come with a numb patch, a constant ache, a red, watering eye or another new symptom, are set off by coughing, or start after 50, but discuss it with your doctor. Many people whose stabs move around, whose examination is normal and who often also have migraine may not need one. In two studies of children with these stabs and a normal examination, every scan was normal.
Blood tests, when you are over 50. Tests for inflammation are the first step when giant cell arteritis is possible.

A few weeks of a headache diary (when the stabs came, where they were, how long they lasted, what you were doing) often makes the pattern clear.

How to Stop Ice Pick Headaches

Most people need no treatment at all. When the stabs are a nuisance, these help.

Knowing what they are. Once a doctor has confirmed the pattern, a stab becomes a nuisance rather than a warning, and for many people that is all they need.
Don't chase each stab with pain relief. A stab is over in seconds, long before any pain relief could work, and taking pain relief every day just in case can itself cause headaches. Keep it to two or three days a week at most: see medication overuse headache.
A medicine for a few weeks, when stabs are frequent. When stabs come often or in runs, a doctor can prescribe a medicine to take for a few weeks. It helps most people who need it: in a Taiwanese headache clinic, about 3 in 4 people who took the usual one improved. Like any medicine it can have side effects, so your doctor will check whether it suits you.
Runs often settle. Runs of frequent stabs often settle by themselves within days to weeks.
Treat the migraine, if migraine is present. Stabs and migraine often go together (in people with migraine, the stabs are often part of the migraine itself), and migraine treatment and prevention are worthwhile in their own right. Not drinking enough water can set off migraine, so drinking enough through the day may help the stabs too.
Brain freeze stops when the cold stops; taking very cold food and drinks more slowly makes it less likely.

Where most people sit

Most people with ice pick headache never need treatment: the stabs are brief, they are usually occasional, and they often come in spells that settle. For the few whose stabs are frequent, treatment helps most people.

When to See a Neurologist About Stabbing Pains in the Head

Stabs that are frequent, come in runs, or are disrupting your day
Stabs that are always in exactly the same spot (see your GP first)
A numb or tingly patch, or a constant ache between the stabs
Stabs with a red, watering eye or a blocked or runny nostril on one side
Pains set off by touching your face, chewing, talking or brushing your teeth
A new headache after 50 (see your GP the same day first)
You want a clear diagnosis and a plan

A consultation involves a detailed history, a neurological examination and a plan: confirming whether the stabs are ice pick headache, looking for any other headache that travels with them (most often migraine), arranging tests when the result will change what happens next, and coordinating with your GP. Dr Ron Granot trained at Prince of Wales Hospital, Sydney, and sees patients in Bondi Junction. For the wider picture, read our migraine overview.

Frequently Asked Questions

What causes a sudden, sharp, stabbing pain in the head that goes away quickly? +

Usually ice pick headache, which doctors call primary stabbing headache: a stab of pain that lasts a second or two, usually one or a few a day, that can strike anywhere on the head and often moves from spot to spot. In a Norwegian study of 1,838 adults, about 1 in 3 had had them, and they are more common in people with migraine. Less often, stabbing pains come from an irritated nerve in the face (trigeminal neuralgia, set off by touch, eating or talking) or at the back of the head (occipital neuralgia, often with a sore or numb scalp), or are the first sign of shingles, before its rash appears: if a rash of small blisters follows, see your GP the same day, or go to an emergency department the same day if it reaches the tip of your nose or your eye becomes red, painful or blurred. New stabs are worth showing your GP. A sudden, severe headache that reaches its worst within a minute and does not go away within seconds is different: call 000.

Can an ice pick headache be an aneurysm or a stroke? +

A typical ice pick stab is neither. An aneurysm (a bulge in the wall of a blood vessel) usually causes no pain until it bursts, and then the headache comes on suddenly and severely, reaches its worst within a minute and does not go away within seconds: call 000. An aneurysm that presses on a nerve can cause double vision, a new drooping eyelid or one pupil larger than the other: call 000. A stroke usually causes sudden weakness or numbness, drooping of the face, trouble speaking or a loss of vision, with or without a headache: call 000 straight away. A stab that is gone within seconds, with nothing else wrong, fits neither.

Could stabbing pains in my head be a brain tumour? +

Very rarely. A few case reports describe stabbing pains as the first sign of a meningioma, a growth of the coverings of the brain that is usually not cancer, which is why doctors pay attention to stabs that are new, always in exactly the same spot, or come with other symptoms. In a large UK study of family-doctor records, fewer than 1 in 1,000 people who saw their GP with a headache were later found to have a brain tumour. Tumours usually cause other symptoms as well, such as weakness, seizures, a change in personality, or a headache that gets steadily worse over weeks, with vomiting. A headache with a seizure, or with new weakness or numbness, needs 000; one that gets steadily worse over weeks, or comes with a change in personality, needs your GP the same day.

Why do I keep getting a stabbing pain in the same spot? +

In about 1 in 3 people with ice pick headache, the stabs keep returning to one spot, and in people with migraine they often strike where the migraine usually hurts. But stabs that are always in exactly the same spot can also come from a problem at that spot or in the nerve that supplies it, so see your GP, who may suggest a scan. A constant ache or a numb, tingly or sore patch between the stabs, or pain set off by touching your face, chewing or brushing your hair, points away from ice pick headache. After 50, pain in the jaw when you chew, with a new headache, needs your GP the same day. A rash of small blisters in that area is shingles: see your GP the same day, or go to an emergency department the same day if it reaches the tip of your nose or your eye becomes red, painful or blurred.

Why am I getting so many ice pick headaches, sometimes for days? +

Most people have one or a few stabs a day, with long gaps between spells. Rarely, the stabs come in runs, many a day for several days, and runs like this often settle by themselves. A run of new stabs in one area of the scalp, forehead or face can be the first sign of shingles, so watch for a rash over the next few days: if one appears, see your GP the same day, or go to an emergency department the same day if it reaches the tip of your nose or your eye becomes red, painful or blurred. Frequent stabs are worth a visit to your GP, who can confirm what they are; when they keep coming, a medicine taken for a few weeks helps most people.

How do I stop ice pick headaches? +

Most people need no treatment: each stab is over in seconds, and most people have only a few. Pain relief cannot work that fast, and taking it every day just in case can itself cause headaches, so keep it to two or three days a week at most. When stabs come often or in runs, a doctor can prescribe a medicine to take for a few weeks, which helps most people. If you have migraine, getting it well treated is worthwhile in its own right. Not drinking enough water can set off migraine, so drinking enough through the day may help the stabs too. Stabs that are new, frequent or always in the same spot should be checked by your GP, and a new headache after 50 needs your GP the same day.

When should I worry about an ice pick headache? +

Call 000 or go to an emergency department if a headache comes on suddenly and severely, reaches its worst within a minute and does not go away within seconds; if it comes with fever and a stiff neck or a rash that does not fade when pressed, confusion, weakness or numbness, drooping of the face, loss of vision, double vision, a new drooping eyelid or one pupil larger than the other, slurred speech, sudden unsteadiness or a seizure; if an eye becomes painful and red with blurred vision or halos; if you are over 50 with a new headache and any blurring, double vision or dimming of sight; or if it started after a head injury and is getting worse or comes with vomiting or drowsiness, or after any head injury if you take blood-thinning medicine. See your GP the same day if it is new after 50, keeps getting worse, is worst on waking or when lying down with vomiting or blurred vision, is brought on by coughing or straining, or comes with a blistering rash or a fever. See your GP if the stabs are new, frequent, or always in exactly the same spot.

Do children get ice pick headaches? +

Yes. In a children's clinic in Turkey, about 1 in 10 children seen for headache had, or probably had, stabbing headache, and in an Italian study the stabs typically began at about 8 years of age. In children the stabs can last longer than in adults, sometimes minutes, occasionally up to half an hour, and many children have migraine or another headache in the family. In two studies, every child with these stabs and a normal examination who had a brain scan had a normal result. A child with new headaches or stabs should see their GP. A sudden, severe headache that reaches its worst within a minute and keeps going, or a headache or stabs with weakness, a change in vision, confusion or a seizure, needs 000.

Important: This page is general health information for adults living in Australia and is not a substitute for individual medical advice. If you have a sudden, severe headache that reaches its worst within a minute and does not go away within seconds, a headache with a stiff neck and fever, a headache or stabs with weakness, numbness or drooping of the face, an arm or a leg, sudden loss of vision, double vision, slurred speech or sudden unsteadiness, a painful red eye with blurred vision, or, if you are over 50, a new headache with blurring, double vision or dimming of sight, or any other warning sign listed at the top of this page, call 000 or go to an emergency department. Diagnosis and treatment decisions are made on an individual basis with your treating doctor.

Stabbing Pains in Your Head?

Book a consultation with Dr Ron Granot — neurologist with a special interest in headache, Bondi Junction. Ask your GP for a referral, then get in touch.

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Call Us02 9388 0615

LocationSuite 301, Bondi Junction

Emailreception@eastneurology.com.au

Last reviewed: 17 October 2026 by Dr Ron Granot, FRACP — Consultant Neurologist, East Neurology, Bondi Junction.