Ice-Pick Headache or Ice Cream type Headache

Typically the patient is young to middle aged and describes a short piercing pain like a flash of lightening lasting from seconds to minutes and may occur several times a day. Ice-Pick headache usually involves one eye and bruised after the pain has gone. Some patients find cold foods trigger the head pain. Sometimes the patient has multiple headache attacks per day on a daily basis.

Management of Ice-Pick Headache

Most patients need reassurance that the attacks are not a result of sinister underlying disease. By the time the patient takes any acute medication, often the pain has disappeared. The gold standard is indomethacin in divided doses. In some patients, daily doses of non-steroidal anti inflammatory drugs such as diclofenac modified release 100mg can abate attacks occuring. Tricyclic antidepressant drugs and anti-epileptic drugs like sodium valproate can also be effective. When the pain lasts for more than three minutes and diffusely affects one side of the head, the term paroxysmal hemicrania is used. Specialist intervention is likely to be required if antidepressants are not effective as a first line treatment.

Source: Dr Andrew Dowson

Publication Date: July 2003

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