Rather new entity is the stabbing headache – primary stabbing headache (PSH) – often in occipital area, happening 2-100 times a day and more occipital (back of head) in location. Treatment is not all what you’d think – its indomethacin, prednisone, gabapentin or tricyclic antidepressants.
Kim, Dong Yeop, et al.
Clinical patterns of primary stabbing headache: a single clinic-based prospective study. The Journal of Headache and Pain 18.1 (2017): 44.
- 65 cases
- Stabbing headaches often described as a jolt
- 69.2% female
- typically presents as one episode up to 40 days average with severity 7/10
- most occipital – 84.6%
- side locked 69.2%
- most range from 2-100 jabs/day
- 72.3% daily
- 73.8% felt as a jolt
- 56.9% persistent
- high relapse rate of jabs
Prednisolone 16.9% – apparently an excellent response which suggested inflammatory origin
Tricyclic antidepressants 9.2%
Comment – not sure how you would differentiate from occipital neuralgia but steroid responsiveness and less jab frequency would suggest the primary stabbing headache (PSH)