Primary Stabbing Headache in A Headache Clinic

Abstract

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.

Clinical features of unilateral headaches beyond migraine and cluster headache and their response to indomethacin

“…Hence, referral to a dentist should be considered in all patients with new onset unilateral headaches not resembling migraine and cluster headache. In case of patients with ultra-short stabbing headaches our data are in line with a previous study [5] showing largely negative imaging results.…”

“…Th e prevalence of paroxysmal hemicrania and hemicrania continua may lie around 5 per 10000 [12,16,17]. In hospital-based studies, primary stabbing headache was diagnosed in 13% of patients with short-duration headache [5] and unilateral tension-type headache was found in 4% and 18%, respectively [18]. Patients with primary headaches reported signifi cantly more attacks within 24 hours than patients with secondary or unclassifi able headaches.…”

“…Accordingly, the authors concluded that even typical TACs can be caused by an underlying lesion and recommended neuroimaging in all patients with a TAC or TAC-like syndrome [4]. In the largest case series of primary stabbing headache published to date only 5% underwent imaging and in these patients there was no evidence of a structural lesion [5].…”

“…Nevertheless, cases of delayed [8] or insuffi cient response [9,10] to therapeutic doses of indomethacin have been published. Indomethacin was also eff ective in primary stabbing headache [5], but not in SUNCT [11].…”

Primary stabbing headache: a new dural sinus stenosis-associated primary headache?

“…Attacks are very short, up to 3 s recurring with irregular frequency. PSH is generally thought to be a primary headache of unknown pathogenesis, mostly occurring in women, commonly associated with migraine and usually responsive to indomethacin [1]. PSH prevalence is not well defined in the general population, but it could be much more frequent than previously thought.…”