Ice Pick Headache: 8 Common Causes & What to Do

Updated in September 2023

Ice pick headaches usually occur due to poor sleep, excess stress, fatigue, dehydration or colds. They may also occur due to a migraine or a tension headache. Although less common, ice pick headaches may also be a sign of a more serious health condition, however, like a stroke, aneurysm or a brain tumor. 

Also referred to as primary stabbing headaches, these types of headaches are sudden and last for seconds. They are described as a sharp pain or a series of sharp pains. 

If you have prolonged or frequent ice pick headaches that do not resolve with medications, it is important to see a family doctor or neurologist for assessment and treatment as necessary. 

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The most common causes of ice pick headaches are:

1. Tension headache

A tension headache can also cause sharp, ice pick headaches. Tension headaches are usually the result of bad posture, anxiety, insomnia, difficulty sleeping or stress. 

Normally, the pain is felt in the forehead, however it can affect other areas of the head as well as neck. The pain usually emerges on its own, without other symptoms like vomiting or nausea. 

What to do: Generally, the pain can be relieved through relaxation techniques, like massages or a hot bath, which help to relieve tension.

Nonetheless, if the pain is persistent or frequent, you are advised to consult a family doctor or neurologist for assessment and treatment. Treatment may involve medications like ibuprofen or amitriptyline. 

2. Migraine

Ice pick headaches caused by migraines generally occur on one side of the head. They are usually triggered by stress, too much or lack of sleep, or after eating certain foods, like chocolate or wine. 

In addition to the sharp pain, migraines can also cause symptoms like vision changes, nausea, vomiting, changes to sleep, and sensitivity to some smells. Read more about migraine symptoms and who is most at risk.

What to do: To treat a migraine and manage the ice pick headaches, the doctor may recommend relaxation techniques, psychotherapy, regularly-timed meals, regular exercise and adequate sleep. 

Nonetheless, if you suspect you may have a migraine, it is important to consult a family doctor or neurologist to confirm a diagnosis and start treatment, which may include the use of medications like ibuprofen, sumatriptan or topiramate to manage flare-ups. 

3. Caffeine withdrawal

When you suddenly stop drinking coffee, it's common to experience symptoms related to caffeine withdrawal, such as headaches, tiredness, difficulty concentrating, mood swings and difficulty thinking.

Symptoms tend to start 12 to 24 hours after you last drank coffee and can persist for up to 9 days in some cases.

What to do: Drinking coffee usually improves the headaches related to a caffeine withdrawal. However, if you wish to stop drinking coffee, it is recommended that you gradually reduce your consumption, as this will help to prevent withdrawal symptoms.

Ice pick headaches that persist even after caffeine reduction or discontinuation should be assessed by a neurologist to determine whether another health condition is contributing to discomfort. The doctor may prescribe analgesics to help relieve mild to moderate pain. 

4. Cluster headaches

A cluster headache is a type of headache that is described as a stabbing sensation in the head. It typically affects just one side of the head. It can also be accompanied by other symptoms, such as redness of the face and tearing and/or pain in the eye. 

What to do: A very severe cluster headache should be assessed in an emergency room. Normally, the pounding in the head and other symptoms improve with the use of a 100% oxygen mask during the crisis.

It is also important to consult a neurologist to confirm the diagnosis and initiate appropriate treatment to prevent further flare-ups.

5. High blood pressure

Some people may experience a headache when their blood pressure is very high, especially if it measures above 180/120 mmHg. In very serious cases, mental confusion, changes in vision and seizures can also occur. Learn more about the symptoms of high blood pressure.

What to do: If you feel an ice pick headache, you should measure your blood pressure to check whether it is high. Abnormally high readings should be assessed urgently,  especially if the blood pressure is above 180 x 120 mmHg. The doctor may prescribe blood pressure medication to lower the pressure, which may help the ice pick headache. 

Once acute high blood pressure is managed, it is important to see a cardiologist within the next few days for an assessment and to check whether there is a need to use antihypertensive drugs on a daily basis or to make adjustments to the doses of the drugs already in use. The doctor may also advise you to start on a high blood pressure diet to help keep your values within normal ranges.

6. Stroke

A cerebral vascular accident, or a stroke, can occur due to decreased blood flow to the brain or due to bleeding within the brain. It can cause a very sudden and intense ice pick headache. 

Strokes are also associated with other symptoms like fainting, vision changes, loss of sensitivity in one part of the body, and difficulty lifting an object or picking one up.

What to do: If you suspect you are experiencing a stroke, call 911 or proceed to an emergency room for assessment. Prompt treatment can help to prevent serious complications. 

7. Brain aneurysm

A brain aneurysm is characterized by the dilation of a blood vessel that takes blood to the brain. This dilation can cause an ice pick headache, double vision, confusion, nausea, vomiting and fainting. Read more about the symptoms of a brain aneurysm

What to do: If you suspect you may have a brain aneurysm, it is important to consult a neurologist for evaluation and diagnosis. Treatment depends on the doctor’s assessment the characteristics of the aneurysm.

Normally, when the aneurysm is small and there is the risk for bleeding is low, the doctor may not prescribe any treatment. However large aneurysm that present with a high risk for bleeding may require surgical repair.  

8. Brain tumor

A brain tumor may occur due to genetics or due to metastases from another type of cancer. Symptoms depend on the location of the brain tumor, and may include ice pick headaches, changes to touch sensitivity, weakness, tingling in the body and imbalance. 

Learn more about the general symptoms of a brain tumor and how they present depending on the area affected.

What to do: If you suspect you may have a brain tumor, you are advised to see a neurologist or family doctor for testing and diagnosis. If confirmed. treatment may involve surgical removal of the tumor, chemotherapy, and radiation therapy. The treatment approach depends on the tumor location, type and size.