IDIOPATHIC INTRACRANIAL HYPERTENSION | 10.01.2023

STABBING HEADACHES

Trigeminal Neuralgia (TN) and Stabbing Headaches

Trigeminal neuralgia is the sudden and severe, electric shock-like pain at any part of the face. It is the most common headache, and a disease of the trigeminal nerve that provides sensation to the face and chewing muscles.

stabbing headaches

Photo: Altan Akay

Trigeminal neuralgia is observed more commonly among women than men. Its annual incidence is between 4-13 per 100,000 people. However, it is still the most common neuralgia in adults. Its incidence increases with age. Most of them are seen after the age of 50 for no underlying reason. However, it can occur in the twenties and thirties and rarely in childhood. Although not very certain, high blood pressure disease and migraine may be a risk factor.

Trigeminal neuralgia, which is the most common stabbing headache, is a sharp and severe pain that comes in attacks. The pain lasts for seconds and covers usually only one half of the face. Rarely, it can be bilateral. Attacks can occur consecutively and recur up to 50 times a day. In patients with long-term TN, blunt pain may persist, outside of attacks. It can be observed on the chin, cheek or around the eyes. Some movements such as touching the face, chewing, talking, brushing teeth, combing hair, smiling, or exposure of the face to cold may trigger the pain. However, TN does not wake the patient at night like some other painful syndromes of the face.

After the diagnosis of trigeminal neuralgia is made, a brain MRI can be performed to determine whether there is a pathology in the trigeminal nerve. Classic TN occurs without an underlying cause other than vascular compression. In most cases, this pressure is caused by a vein. Rarely though, tumours, cysts or vessel bubbles may be the cause of such pressure. Multiple sclerosis and brain stem lesions are other causes of TN. In some patients, TN can be seen without any underlying cause, which we refer to as idiopathic.

Treatment is usually implemented with medication. Treatment is regulated with drugs used for epilepsy, such as carbamazepine. These drugs work by stopping the nerve transmission that causes pain. Sometimes surgical treatments may be required.

Glossopharyngeal Neuralgia (GPN)

Glossopharyngeal neuralgia is a unilateral, repetitive, electric shock-like pain involving the base of the tongue, pharynx, tonsils, ear and jaw corner. It is typically triggered by yawning, swallowing, coughing, or speaking. The attack duration is usually between 2 seconds and 2 minutes. It is rare. A decrease in heart rate and blood pressure, epileptic seizures and even cardiac arrest have been described with GPN. For this reason, patients with complaints such as dizziness, palpitations and fainting in addition to pain should have their heart rhythms monitored. Just like TN, it can occur with vascular compression. Other causes are demyelinating diseases, tumours and infections.

Short Lasting Unilateral Neuralgiform Headache Attacks (SUNHA)

SUNHA is another rare type of sudden stabbing headache. The typical age of onset is between 30-60 years and is more common in women. In SUNHA, the pain is unilateral, severe, reamer and electric shock like. It comes in attacks and there must be at least 1 attack per day. The attack can occur as a single attack or it can come back to back. Autonomic symptoms on the same side as the pain, i.e. eye redness and tearing, nasal congestion or discharge, eyelid oedema, constriction of the pupil or sweating on the forehead, must be accompanied by at least one of the symptoms. SUNHA is divided into SUNCT and SUNA. Eye redness and tearing occur together in SUNCT, while SUNA should have only one or none of these. Just like in trigeminal neuralgia, there may be movements that trigger pain. Since the pain is very short-lived, the treatment is anti-attack. It is also treated with drugs used in epilepsy.

Icepick Headache

An icepick headache is another type of sudden stabbing headache. The pain is temporary, sharp, stabbing. Its incidence is 2-35%. It can happen anywhere on the head. It can occur suddenly, in the form of single or consecutive flashes. Stabbing typically lasts seconds and comes at irregular intervals. It can happen several times a day, or it can be a single attack. Pain is not accompanied by autonomic symptoms such as eye redness and tearing, runny nose, eyelid oedema, facial sweating and flushing. The reason is unknown. Most patients also have another primary headache, such as a cluster headache, like a migraine. Usually no treatment is required. Melatonin and indomethacin may be helpful when needed.

SOURCES: Headache Continuum June 2021 Vo:27 No:3
Ho CC, Khan SA, Whealy MA. Trigeminal neuralgia Up to Date August 2020

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