4.7.1 Probable primary stabbing headache

A patient who works as a schoolteacher reports headache that comes as sudden, needle-like jabs shifting between the vertex and the left parietal region, without any preceding warning. Each jab is gone within about two minutes, and she now counts them at roughly twice a day, most often while sitting at her desk marking schoolwork. She specifically denies tearing, conjunctival flushing, forehead sweating or nasal blockage on the affected side during an episode, and there is no drooping eyelid. She characterises the quality as sharp and stabbing rather than throbbing, and reports no nausea, no visual aura and no sensitivity to light.