title: Paroxysmal stabbing headache in the multiple dermatomes of the head and neck: a variant of primary stabbing headache or occipital neuralgia?
abstract: A paroxysmal stabbing or icepick-like headache in the multiple nerve dermatomes, especially involving both trigeminal and cervical nerves, has not been fully explained or classified by the International Classification of Headache Disorder, 2(nd) Edition (ICHD-II). Of patients with acute-onset paroxysmal stabbing headache who had visited the Hallym University Medical Center during the last four years, 28 subjects with a repeated stabbing headache involving multiple dermatomes at the initial presentation or during the course were prospectively enrolled. All patients were neurologically and otologically symptom free. A coincidental involvement of both trigeminal and cervical nerve dermatomes included seven cases. Six cases involved initially the trigeminal and then cervical nerve dermatomes. Five cases showed an involvement of the cervical and then trigeminal nerve dermatomes. The remaining patients involved multiple cervical nerve branches (the lesser occipital, greater occipital and greater auricular). Pain lasted very shortly and a previous history of headache with the same nature was reported in 13 cases. Preceding symptom of an infection and physical and/or mental stress were manifested in seven and six subjects, respectively. All patients showed a self-limited benign course and completely recovered within a few hours to 30 days. Interestingly, a seasonal gradient in occurrence of a stabbing headache was found in this study. A paroxysmal stabbing headache manifested on multiple dermatomes can be explained by the characteristics of pain referral, and may be considered to be a variant of primary stabbing headache or occipital neuralgia.
authors.affiliation: Department of Neurology, Kang-Dong Sacred Heart Hospital, College of Medicine, Hallym University, 445 Gil-dong, Kangdong-gu, Seoul 134-701, Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Shin
authors.forename: H K
authors.initials: HK
authors.lastname: Song
authors.forename: J H
authors.initials: JH
authors.lastname: Lee
authors.forename: W K
authors.initials: WK
authors.lastname: Kim
authors.forename: M K
authors.initials: MK
authors.lastname: Chu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006257:Head / Q000294:innervation*; D051270:Headache Disorders, Primary / Q000145:classification* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000294:innervation*; D019547:Neck Pain / Q000209:etiology; D010147:Pain Measurement; D014276:Trigeminal Nerve