OBJECTIVES/BACKGROUND: This study was undertaken to assess the prevalence of primary stabbing headache (PSH) among adult patients seeking medical attention for headache in a clinic-based setting. PSH is a primary headache disorder and is one of the representatives of indomethacin-responsive cephalalgias. The epidemiology of PSH in adult patients assessed for headache in a tertiary care setting remains not well established. METHODS: PubMed, Embase, MEDLINE, and ScienceDirect databases were thoroughly searched for observational studies published between January 1, 1988, and August 9, 2024, that reported the relative frequency of PSH among adult patients evaluated for headache in a clinic-based setting. The Meta-Analysis of Observational Studies in Epidemiology guidelines were strictly followed by the study's design. Risk of bias was assessed using the Joanna Briggs Institute Checklist for Studies Reporting Prevalence Data. The study's protocol was preregistered on PROSPERO (ID: CRD42024573776). RESULTS: Of the initial 1153 records, 15 articles (n = 35,904 individuals) met all of the eligibility criteria. Most of the studies revealed a low risk of bias. The prevalence of PSH among adult patients evaluated for headache in a tertiary care setting was 1.6% (95% confidence interval [CI] = 0.7-3.4, 95% prediction interval [PI] = 0.00-0.29), with substantial heterogeneity (I CONCLUSION: Our results showed that PSH is a rare headache disorder among adults evaluated for headache in a clinic-based setting. Moreover, PSH is typically diagnosed in the early fourth decade of life and predominantly in females.