Epicranial headache part 1: Primary stabbing headache

Abstract

Background/objective Primary stabbing headache is a common but under-recognized primary headache disorder. The objectives of this review were to provide practical information for better understanding and identification of the disease, suggest an algorithm for differential diagnosis, and provide an insight into the pathophysiology of primary stabbing headache hypothesized from its clinical course. Methods This narrative review of primary stabbing headache is based on a literature search and the authors’ clinical reasoning. Result The phenotype of each stab is typically abrupt, ultrashort-lasting (<3 s), focal or multifocal, paroxysms of pain occurring sporadically or in clusters. The diagnosis of primary stabbing headache is clinical; fixed or migrating stabs without background pain or sensory abnormalities and the absence of features suggestive of other disorders (e.g., cranial autonomic symptoms or signs) can aid in the diagnosis of primary stabbing headache. The clinical patterns include monophasic, intermittent, and chronic primary stabbing headache, of which the first two are considered typical. The pathophysiology of primary stabbing headache has not yet been elucidated. In this review, we postulated the mechanism of stabbing headache, based on the pain phenotype and clinical course, and provide a clinical algorithm for the differential diagnosis of primary stabbing headache. Conclusion Knowledge about the typical manifestations and clinical patterns of primary stabbing headache will aid in the proper diagnosis and differential diagnosis. Treatment should be tailored by considering the clinical patterns. Further research is needed to elucidate the pathophysiological mechanisms and optimal treatment of primary stabbing headache.

Long-term outcomes of nummular headache: A series of 168 patients and 1198 patient-years of follow-up

“…NH is not as frequent as other prevalent headache disorders, such as tension-type headache or migraine, but its incidence could be estimated to be 8.6 cases per 100,000 patient-years, an estimation similar to those of central nervous system cancer (11 cases per 100,000 patient-years), myelopathies (13 cases per 100,000 patient-years) and amyotrophic lateral sclerosis (5 cases per 100,000 patient-years) (17). Previous studies have reported data on the clinical phenotype of NH and the patient response to treatment (1,3,6,10,18), but its long-term nature has not yet been characterized (5).…”

“…Interestingly, the proportion of patients with prior history of migraine was slightly higher than expected in our setting because the prevalence of migraine in Spain is 12.6% (24) and 17.2% of patients in our population had a previous history of migraine. On the other hand, NH is frequently associated with epicrania fugax (5,25).…”

“…NH incidence is estimated to be between six and nine cases per 100,000 people per year, although it may be underestimated (3). Since its first description, more than 500 cases have been reported in the literature, characterizing its clinical phenotype and response to acute and preventive treatments (4,5). However, data regarding the natural history of NH and outcomes during long-term follow-up are not currently available (6).…”

Other primary headaches: Distinct clinical features and uncertain pathophysiology

“…Primary stabbing headache (PSH) belongs to this group and is perhaps the most common primary headache after migraine and tension-type headache in the general population. Kwon et al reviewed the epidemiology and symptomatology of stabbing headaches (4). Even though secondary headaches may sometimes present with stabbing features, the majority of patients have a primary headache and self-limiting disease course.…”

“…Kwon et al. reviewed the epidemiology and symptomatology of stabbing headaches (4). Even though secondary headaches may sometimes present with stabbing features, the majority of patients have a primary headache and self-limiting disease course.…”