- Advances in Primary Stabbing Headache: Diagnostic Criteria, Epidemiological Insights, and Tailored Treatment Approaches
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Ayush Chandra, Avinash Chandra, Soohyun Cho
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Headache Pain Res. 2025;26(1):80-87. Published online September 2, 2024
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DOI: https://doi.org/10.62087/hpr.2024.0018
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- Primary stabbing headache (PSH), characterized by sudden, localized stabbing headache pain, is a recognized primary headache disorder with evolving diagnostic criteria. Epidemiological studies show a wide range of prevalence, influenced by various factors. PSH is more common in females, frequently occurring in conjunction with migraine, and can manifest in children. Recent diagnostic criteria have changed the definition of sharp stabbing pain, which is no longer restricted to the first division of the trigeminal nerve. In addition, the criterion of “no accompanying symptoms” has been refined to “no cranial autonomic symptoms” specifically. These changes have increased the sensitivity for capturing PSH. Although it is generally considered benign, stabbing headache can be associated with secondary causes. Clinical red flag signs can be helpful in distinguishing secondary headaches from PSH. A recent prospective study has proposed the monophasic, intermittent, and chronic patterns as subtypes, and this division may be helpful for predicting the prognosis. Pharmacological treatment is typically not required for PSH, although indomethacin and other alternating agents can be used. The treatment should be selected based on individual clinical features and comorbidities. This review aims to highlight the necessity of recognizing the distinctive clinical profile of PSH and of tailoring treatment approaches to patients’ individual needs.
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Citations
Citations to this article as recorded by  - Tension-Type Headache and Primary Stabbing Headache: Primary Headaches Beyond Migraine
Mi-Kyoung Kang
Headache and Pain Research.2025; 26(2): 89. CrossRef - Two-year prognosis of primary stabbing headache and its associated factors: a clinic-based study
Soohyun Cho, Byung-Kun Kim
The Korean Journal of Pain.2025; 38(3): 332. CrossRef
- Gepants for Migraine: An Update on Long-Term Outcomes and Safety Profiles
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Soohyun Cho, Kimoon Chang
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Received August 5, 2025 Accepted September 4, 2025 Published online September 11, 2025
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DOI: https://doi.org/10.62087/hpr.2025.0012
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Abstract
- Calcitonin gene-related peptide receptor antagonists, also referred to as gepants, represent a transformative advancement in migraine pharmacotherapy, providing both acute and preventive treatment options without the vasoconstrictive limitations of triptans. Since their initial approval in 2019, gepants have gained widespread clinical adoption, necessitating comprehensive evaluation of their long-term safety and efficacy. This review synthesizes current evidence on four calcitonin gene-related peptide receptor antagonists (rimegepant, atogepant, ubrogepant, and zavegepant) derived from pivotal trials, open-label extension studies, and real-world observational data. Rimegepant demonstrates sustained efficacy and minimal adverse events over 52 weeks, with no evidence of medication-overuse headaches or hepatotoxicity. Atogepant maintains progressive clinical benefits and favorable tolerability for up to 1 year, exhibiting low rates of treatment-emergent adverse events and discontinuation. Ubrogepant remains effective and well-tolerated during long-term intermittent use, with no clinically significant safety signals over extended exposure. Zavegepant, the first intranasal gepant, shows promising long-term tolerability, with the most frequently reported localized adverse event being transient dysgeusia. No consistent hepatic, cardiovascular, or serious systemic toxicity has emerged for any of the agents, and discontinuation rates due to adverse events remain consistently low. Current evidence supports gepants as safe and effective therapies for long-term migraine management, although ongoing surveillance and extended-duration studies remain essential to fully characterize their safety profile, particularly in high-risk populations and combination therapy scenarios. In conclusion, gepants offer a well-tolerated, non-vasoconstrictive alternative for migraine patients who require sustained treatment, representing a significant therapeutic advancement in migraine.
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