What Is Ophthalmodynia Periodica?
An ice-pick headache that affects the eyes
Jamie Grill / Getty Images
Medically reviewed by Huma Sheikh, MD
Ophthalmodynia periodica is a headache disorder first discovered in 1964. The International Headache Society officially changed its name to primary stabbing headache decades later.
Primary stabbing headache causes sudden and sharp pains, often likened to getting jabbed with an ice pick. The headache is known as ophthalmodynia periodica when the stabbing pains affect the eyes (and not other head areas).
This article will review the symptoms, causes, diagnosis, and treatment of ophthalmodynia periodica. Other names for this headache include "ice-pick headache," "jabs and jolts syndrome," and "needle-in-the-eye syndrome."
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Ophthalmodynia Periodica Symptoms
Ophthalmodynia periodica is a sudden and severely sharp headache that manifests around the eyes as a single stab or a series of stabbing pains.
The headache can occur around one or both eyes, and the jabbing sensation is usually brief, lasting three seconds or less. In rare instances, the headache can for up to two minutes.
Ophthalmodynia periodica also occurs in irregular intervals. Though most people report daily or near-daily attacks that last days to weeks, some experience a few headache attacks (not exceeding one day) over a month or year. A chronic pattern in which the headaches occur daily over a long period is also possible but considered extreme.
Symptoms that may accompany ophthalmodynia periodica include:
Light sensitivity (photophobia)
Sound sensitivity (phonophobia)
Nausea and vomiting
Dizziness
Causes
The precise cause of ophthalmodynia periodica (and primary stabbing headaches generally) remains unknown.
Some research suggests an inflammatory or viral cause. Central sensitization—a phenomenon in which nerve cells become increasingly responsive to stimulation—may also be involved.
Though more studies are needed to understand why this headache develops, experts have found that gender and a history of migraines influence a person's risk of developing it. Specifically, primary stabbing headache is more common in people assigned female at birth and individuals with migraine.
Related:Primary Stabbing Headache and Possible Link to Autoimmunity
Diagnosis
Ophthalmodynia periodica is considered a benign (harmless) primary headache disorder. That said, the headache is a diagnosis of exclusion, meaning other more secondary severe causes must be ruled out first.
Primary headache disorders exist on their own, whereas an underlying health-related issue, such as illness, pregnancy, or caffeine/drug withdrawal, causes secondary headaches.
Diagnosing ophthalmodynia periodica requires a person to meet the criteria for primary stabbing headaches as established by the International Headache Society.
A neurologist (a doctor specializing in nervous system conditions) performs a detailed medical history and neurological examination to assess for the following criteria:
Head pain occurs spontaneously as a single stab or series of stabs.
Each stab lasts for up to a few seconds.
Stabs recur irregularly, from one daily to many per day.
No cranial autonomic symptoms—eye tearing/swelling, runny/stuffy nose, forehead/facial sweating, pinpoint pupil (miosis), and drooping of the upper eyelid (ptosis)—are present.
Not better accounted for by another headache diagnosis
The absence of cranial autonomic symptoms is critical because ophthalmodynia periodica resembles a group of headache disorders called trigeminal autonomic cephalgias (TACs).
Cranial autonomic symptoms occur with TACs. Types of TACs include:
A cluster headache is an excruciatingly sharp or stabbing one-sided headache localized in or around the eye or temple.
Paroxysmal hemicrania is a severe one-sided headache that usually lasts two to 30 minutes.
Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome includes red or bloodshot eyes (conjunctival injection), swollen eyelids, and watery eyes.
Besides TCAs, ophthalmodynia periodica also resembles trigeminal neuralgia, a facial pain syndrome caused by irritation or compression of the fifth cranial nerve.
During the diagnostic process, a healthcare provider may also order tests like a brain magnetic resonance imaging (MRI) scan to rule out secondary causes of a stabbing headache.
Examples of possible secondary causes include:
Shingles (herpes zoster)
Structural brain abnormalities like a meningioma, pituitary tumor, aneurysm, or arteriovenous malformation
Related:What Is a Headache Specialist and Do You Need One?
Treatment
If you or a loved one is diagnosed with primary stabbing headaches, you will probably only require treatment if your headache attacks are severe or debilitating.
The first-line medication for primary stabbing headaches is a prescription non-steroidal anti-inflammatory medication (NSAID) called Indocin or Tivorbex (indomethacin).
Due to its potential harm, not everyone can take indomethacin (or other NSAIDs). Therefore, only take an NSAID under the guidance of a healthcare provider.
Possible NSAID side effects include stomach bleeding, high blood pressure, and kidney problems. Also, NSAIDs increase a person's risk of heart attack, heart failure, or stroke.
If indomethacin doesn't work or cannot be taken, the dietary supplement melatonin may be recommended. As with any drug or supplement, a healthcare provider should be consulted before taking melatonin. Side effects linked to it include dizziness, headache, and sleepiness.
Related:How Headaches Are Treated
Coping
Experiencing ophthalmodynia periodica is painful and perhaps distressing in the moment. But research suggests an overall good prognosis. Even if treatment is required, you can typically taper the medication off as symptoms resolve.
If your healthcare provider has prescribed you indomethacin, taking the medication as directed is important. Besides preventing side effects, you want to avoid developing a medication-overuse headache. This potentially disabling headache can occur if you take painkillers too often.
Also, remember not to self-diagnose ophthalmodynia periodica or any headache. See a healthcare provider for a proper evaluation if you are experiencing stabbing headaches around your eye or anywhere on your face or scalp.
Related:When Should You Worry About a Headache?
Summary
Ophthalmodynia periodica, also known as primary stabbing headache or "ice-pick headache," causes a single or series of sharp, jabbing pains around the eye. The headache occurs irregularly, ranging from rare to daily attacks, and the pain is typically short-lived, lasting a few seconds.
The diagnosis of ophthalmodynia periodica requires that a person meet specific clinical criteria. Imaging or other diagnostic tests may be ordered to rule out secondary causes (e.g., tumor, brain inflammation, stroke). Treatment is not always necessary; however, if it is, trying indomethacin is a typical first treatment.
