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

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.

Causes

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).

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

Diagnosis

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 brain scans like magnetic resonance imaging (MRI) to rule out worrisome conditions before confirming a diagnosis.

Treatment

Treatment of primary stabbing headache 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 side effects.

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

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

The Autoimmune Connection

Science suggests that, in some people, autoimmune disease and a primary stabbing headache are related.

An autoimmune disease is a condition characterized by your 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 of MS, Sjögren'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:

• Systemic lupus erythematosus
• Behcet's disease
• Antiphospholipid antibody syndrome
• Vasculitis
• Clinically isolated syndrome (the first episode of multiple sclerosis)
• Lyme disease (not classified as autoimmune but possibly related to autoimmunity)

The precise mechanism behind how these conditions trigger stabbing headaches is unclear, but based on the demyelination findings in some 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 yet be detected on MRI.

A 2013 case study (a report on an individual patient), also found an association between primary stabbing headache and MS. It involved a young woman who had 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 are 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 alter how your doctor treats your stabbing headaches. For instance, they may consider steroids to calm down your stabbing head pain if you also have an autoimmune condition.

A Word From Verywell

As always, speak with your doctor if you have any medical concerns so you can create a proper diagnosis and treatment plan.

When it comes to primary stabbing headaches, the good news is that most people don't experience persistent symptoms. If you do, you have some effective treatment options to explore.