I would also get pin prick pain somewhere on my face, usually cheek or nose. It ended up being one of the cervical vertebrae were out of place, and once it was put back I never had an issue again. So I wouldn't be surprised if it's a pinched nerve or similar neck issue in your case.
I had an MRI that showed nothing unusual. I've never seen a chiropractor.
If someone found something out of place and put it back, and solved my issue, I would be the happiest person on Earth for a while.
My neck also felt unstable. Like my head would "slide off" if I tilted it wrong. My cervical vertebrae also would click in certain positions.
It was actually a physical therapist that fixed it. I had gone to them to "stabilize" my neck. They noticed that I couldn't turn my head to the left as far as I could to my right. We did ~2 months of exercises and one day they tried manipulating one of my cervical vertebrae and it was like night and day. I felt a rush of blood up into the left side of my brain and that night I slept great. It took a couple more weeks of exercises to stabilize the new position (other things started to move now that it was better aligned). And I haven't had any issues since.
I hope it's the same for you! I understand what it's like and it's awful. I think in my case it was more of a rotation problem so that might not show up as well on x-ray. Idk what other imaging would be better (if any). It might be worth getting a physical therapist to check out your neck mobility and see if there's anything noticeable. Best of luck.
Also you might need to try more than one physical therapist. Some are much better than others.
Of course the experience isn't exactly the same for everyone - personally the headache I experience during a migraine isn't throbbing, but it is very much one-sided and concentrated behind my eye (which is common for migraines). But I think basically from the diagnosis perspective, if connecting the dots (symptoms) results in a picture of a duck (migraine), then it is a duck. If connecting the dots doesn't result in a duck picture because there aren't enough dots, or if connecting some of the dots creates a duck picture but there are left over dots that don't connect - that's when from the doctor's perspective further work up might be needed because it's not clear what the cause is.
For me at least, how I distinguish between other headaches and a migraine is that with migraine the headache is just one of the reasons I feel terrible. It's similar to having a concussion in a lot of ways and more severe migraines can be a little bit like having the flu as well. I'm kind of dazed, struggle to remember things, and trying to think feels akin to running on sand. Sometimes music starts to sound like random noise without any musical quality. Beyond just physical activity making the headache worse, I feel physically weak and tired. During more severe migraines, I often experience rapidly alternating chills and hot flashes. Sometimes NSAIDs will help with only the headache and, even though my head doesn't hurt that much anymore, sitting upright can still be unbearable. Merriam Webster defines malaise as "an indefinite feeling of debility or lack of health" and that's the best description I can come up with for the feeling of having a terrible migraine even when the headache itself is better. All in all, during a migraine I get the distinct impression that my brain is not functioning properly.
If a lot of that resonates, then you're probably also experiencing migraines. And if not, then that's the difference between what you described and migraine. "Cervicogenic headaches" also might be a thing that can cause headaches similar to a migraine and sound kind of like what you're describing. But I believe there's some debate in the medical community about whether migraine-like "cervicogenic headaches" are actually a separate condition or if it's just a way that migraines can present.
Turned out my cranial pressure was too high. Had some fluid drained off, and symptoms resolved that night and lasted a year.
Diamox helps me now. But lots of side effects.
What's the difference between that and migraine? I hear people all the time saying they suffer from migraines, and I'm told it's connected to a 'quadrant' type of pain. Are people being diagnosed with migraines maybe suffering from a similar nerve issue that I have? And by the way, that I have a nerve impingement is purely my own hypothesis, and difficult to prove/disprove I think.