Differential Diagnosis for Chronic Unilateral Top of Skull Ice Pick Headache
- Single most likely diagnosis
- Ice Pick Headaches: Also known as primary stabbing headaches, these are characterized by brief, sharp, stabbing pains, often described as feeling like an ice pick is being driven into the skull. They can occur anywhere on the head, including the top, and are typically unilateral. The pain is usually severe but very short-lived, lasting only a few seconds.
- Other Likely diagnoses
- Cluster Headaches: While cluster headaches are typically more prolonged and associated with other symptoms like nasal congestion and eye watering, they can sometimes present with sharp, stabbing pains. They are strictly unilateral and can occur in the area described.
- Tension-Type Headaches: Though less likely to be described as "ice pick," tension-type headaches can sometimes have a sharp quality, especially if they are severe. They are often bilateral but can be unilateral and may involve the top of the skull.
- Occipital Neuralgia: This condition involves inflammation of the occipital nerves and can cause sharp, stabbing pains in the back and top of the skull. It is usually unilateral.
- Do Not Miss diagnoses
- Subarachnoid Hemorrhage: Although the classic presentation is a "thunderclap headache," some patients with subarachnoid hemorrhage may experience warning leaks that could manifest as sudden, severe, stabbing headaches. This is a medical emergency.
- Temporal Arteritis: This condition, also known as giant cell arteritis, can cause severe, stabbing headaches, usually in older adults. It is a medical emergency due to the risk of vision loss.
- Meningitis: Inflammation of the meninges can cause severe headaches, which might be described as stabbing or sharp, especially in the early stages. This is a medical emergency.
- Rare diagnoses
- Trigeminal Neuralgia: Typically involves the face rather than the top of the skull, but in rare cases, it could present with pain in this area. It is characterized by sudden, severe, stabbing pains.
- Cervicogenic Headache: These headaches are referred from the cervical spine and can present with a variety of pain patterns, including sharp, stabbing pains in unusual locations like the top of the skull.
- Headache due to Cranial Bone Lesions: Various lesions (e.g., metastases, multiple myeloma) can cause localized pain, which might be described as sharp or stabbing, depending on the location and involvement of nerve endings.