Overview of Primary Stabbing Headache and a Link to Autoimmune Disease

Primary stabbing headache is a chronic primary headache disorder, meaning the stabbing head pains are not caused by an underlying medical condition. In other words, this type of headache exists on its own without another health explanation.

Symptoms of primary stabbing headache include:

• A single stab or series of stabbing pains in the head (like "ice-pick pains" or "jabs and jolts").
• Short acting, typically lasting three seconds or less.
• Stabs appear in an irregular manner, occurring once to a few times a day (although it can occur up to 50 or even 100 times a day).
• Stabs may occur repetitively over days, but this is rare.

Experts believe the disorder is relatively rare, although studies have ranged in reporting how common it is (2 percent to 35 percent). 

Experts believe that the origin of this headache stems from irritation of trigeminal nerve endings. This is because the pain of this headache disorder is felt in the distribution of the first branch of the trigeminal nerve (around the eye, temple, and side of the head).

To clarify, primary stabbing headache is a distinct condition from another pain-related disorder called trigeminal neuralgia.

A primary stabbing headache can be tricky to diagnose, as it can coexist, and even occur simultaneously, with other headache disorders like migraines or cluster headaches. In addition to a thorough history and neurological examination, doctors may perform imaging like an MRI scan of the brain to rule out worrisome conditions before confirming a diagnosis.

If diagnosed, treatment may entail taking Tivorbex (indomethacin), which is a non-steroidal anti-inflammatory medication (NSAID). However, indomethacin may not work for some people, up to one-third, and may cause kidney or gastrointestinal adverse effects. 

Other potential medications a doctor may prescribe for primary stabbing headache include:

• Celebrex (celecoxib): a COX-2 inhibitor
• Neurontin (gabapentin)
• Melatonin

Science suggests that in some people there may be a connection between their autoimmune disease and a primary stabbing headache. An autoimmune disease is a condition characterized by a person's immune system attacking normal, healthy organs. For example, in multiple sclerosis, immune cells attack nerve coverings in the brain and spinal cord.

One Italian study in Clinical Neurology and Neurosurgery examined 26 people with a diagnosis of primary stabbing headache. The researchers found that of these 26 people, 14 had an autoimmune disease. In addition, seven of those 14 people had evidence of myelin loss (called demyelination) on an MRI. Those with evidence of demyelination included people with a diagnosis MS, Sjogren's syndrome, or vasculitis.

The other seven people with both primary stabbing headache and an autoimmune disease did not have evidence of demyelination on their MRI. These people had the following autoimmune conditions:

• Lyme disease
• Systemic lupus erythematosus
• Behcet's disease
• Antiphospholipid antibody syndrome
• Vasculitis
• Clinically-isolated syndrome (the first episode of multiple sclerosis)

The precise mechanism between how these conditions possibly trigger stabbing headaches is unclear, but based on the demyelination findings in seven of the participants, authors hypothesize that a demyelinating injury of an area in the brain may be responsible.

What about the other seven who did not have demyelinating findings? It's hard to say, but the authors suggest it's possible the demyelination simply could not be detected on MRI.

Another study, which was a case study (a report of an individual patient), found an association between primary stabbing headache and multiple sclerosis. In this study, a young female developed episodes of stabbing headaches, up to 100 times a day. 

During one episode, the stabbing head pains were associated with numbness and tingling of her right arm. Her headaches and neurological symptoms resolved with steroids, which is used to treat relapses in multiple sclerosis.

Remember, an association does not imply causation. Just because you have stabbing headaches does not mean you also have an autoimmune condition and vice versa. This is simply an interesting link and warrants more research to better understand the "why" behind it.

That being said, this connection may also alter how your doctor treats your stabbing headaches. For instance, he may consider steroids to calm down your stabbing head pain if you also have an autoimmune condition.

As always, speak with your doctor if you have any medical concerns in order to create a proper diagnosis and treatment plan. When it comes to primary stabbing headaches, the good news is that most people do not experience persistent symptoms, but if they do, there are some effective treatment options.