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A 40 year old migraineur reports brief shock like pain over the parietal scalp lasting seconds. They occur at variable frequency through the day and occur on either side. There are no precipitating factors and no autonomic features. Neurological examination is normal. What is the most likely diagnosis?
Explanation
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Primary stabbing headache or ice pick headache is characterized by brief stabbing pain lasting 1-2 seconds. They occur at irregular frequency and are not associated with autonomic features or triggers. This differentiates them from trigeminal autonomic cephalalgia and neuralgia. It is more common in migraine. Normal neurological exam and absence of red flags preclude further testing. It does not require treatment other than reassurance.
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Reference
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Starling AJ. Unusual Headache Disorders. Continuum 201824(4 Headache)1192-1208
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Option 1
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Is Correct (Option 1):
Trigeminal neuralgia
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Option 2
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Is Correct (Option 2):
Trigeminal autonomic cephalalgia
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Option 3
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Is Correct (Option 3):
Idiopathic intracranial hypertension
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Option 4
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Is Correct (Option 4):
Primary stabbing headache
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