How do you manage patients with ice-pick headaches?

Ice-pick headaches, previously known as jabs & jolts and now often referred to as stabbing headaches, also manifest as stabbing face pain, which can be mistaken for trigeminal neuralgia due to lack of awareness. They can strike the head or the face suddenly, resembling lightning bolts. While common in patients with migraine or cluster headaches, they typically occur only occasionally. Under such circumstances, they do not require treatment other than reassurance that they are not caused by structural neurological illness, which they never are. However, I have also seen them occurring daily, hundreds of times per day, and causing significant disability. The established treatment of stabbing headache or stabbing face pain is with indomethacin...

I agree with Dr. @Dr. First Last' answer. The problem with long-term indomethacin use though is that it can be tough on your stomach and your kidneys after long-term use. It could lead to increased bleeding in patients who are on other antiplatelets/anticoagulation for other medical conditions.

Recently in a few patients with indomethacin-responsive headache syndromes, I have had some success with conversion to Boswellia serrata supplements. I have been able to completely take them off indomethacin or at least reduce the daily indomethacin dose.