A new variant nummular headache: large diameter accompanied with bitrigeminal hyperalgesia and successful treatment with carbamazepine

Man, Yuhong; Yu, Tingmin; Li, Li-Sen; Yao, Gang; Mao, Xijing; Wu, Jinghai

doi:10.5137/1019-5149.jtn.3960-10.0

Cited by 8 publications

(10 citation statements)

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“…Similarly, infiltration of local anesthetics did not relieve pain in the majority of cases. A few interesting case descriptions such as large diameter NHs with bitrigeminal hyperalgesia[11] and a case of NH in which pain recurred even after focal scalp resection of the affected area[6] have also favored a central causation of NH. In this regard, it is interesting that one of our patients also had preexisting trigeminal neuralgia.…”

Section: Discussionmentioning

confidence: 99%

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Nummular headache: Clinico-epidemiological features in South Indian population

Rammohan

Mundayadan

Mathew

2016

Journal of Neurosciences in Rural Practice

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Context:Nummular headache (NH) is a primary disorder characterized by head pain exclusively felt in a small-rounded area typically 2–6 cm in diameter.Aims:The aim of this review is to study the clinical and epidemiological features of NH in a patient population of South India and to compare this with that of described in the international literature.Settings and Design:A prospective, observational study conducted in a tertiary care center.Materials and Methods:Patients attending the medicine and neurology outpatient departments of a tertiary referral hospital in South India diagnosed to have NH as per the International Classification of Headache Disorders 3 beta (2013) criteria were studied over 30 months. All of the patients had a normal neurological examination. Neuroimaging findings were normal, except in one patient.Results:A total of 19 females and 10 males were studied. The mean age of onset was 47.62 years (range 36–60). The duration of headache varied from a minimum of 3 months to a maximum of 5 years, with a mean of 24.17 months. The site of headache was predominantly in the parietal area 15 (51.72%), followed by the occipital area 7 (24.13%). The mean diameter of the affected area was 3.23 cm. The intensity of the headache proved to be mild to moderate with a mean visual analog scale score of 5.03. The quality of pain was mainly felt as burning dysesthesia 12 (41.38%). In the majority of patients, i.e. 21 (72.41%), pain was chronic and continuous. None of the patients had any significant trophic change even though paresthesias, dysesthesias, and allodynia were reported by a significant minority of patients, i.e. 9 (31.03%). Only one (3.45%) patient gave a history of head injury. Ten (34.48%) out of 29 patients had other types of concurrent headaches; the majority of which proved to be migrainous, i.e. 7 (24.14%), 2 patients (6.89%) with tension headache, and 1 patient (3.45%) with trigeminal neuralgia.Conclusion:Our study proves the existence of the newly described primary headache syndrome called NH in South Indian population. In comparing our results with the international literature, the number of similarities is much greater than the differences. The etiology of pain in our series appeared to be primarily peripheral with a role for central pain sensitization in some cases due to a variety of concurrent central causes of head pain.

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Section: Discussionmentioning

confidence: 99%

“…have also proposed that a minority of trigeminal afferents arise ipsilaterally to the thalamus and sensory cortex regardless of nociceptive or nonnociceptive signals and that this neuroanatomic minority is responsible for pain of NH. [11]…”

Section: Discussionmentioning

confidence: 99%

Nummular headache: Clinico-epidemiological features in South Indian population

Rammohan

Mundayadan

Mathew

2016

Journal of Neurosciences in Rural Practice

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“…Gabapentin seems to be the most used preventive treatment for NH, although the results are inconsistent . Other treatments potentially helpful are naproxen, indomethacin, cyclobenzaprine, nortriptyline, carbamazepine, lamotrigine, neurotropin®, and transcutaneous electrical nerve stimulation …”

Section: Resultsmentioning

confidence: 96%

“…Some patients have shown trophic changes within the painful area, including thinness of the skin, and one patient had hair heterochromia at the pain site . There are a few cases reported with the painful area larger than 6 cm of diameter – up to 10 cm . Some studies have shown evidence of increased sensitivity – a lower pain threshold with pressure algometry – restricted to the symptomatic area, with no pericranial tenderness in the remainder of the scalp, and with no signs of a generalized pain state …”

Section: Resultsmentioning

confidence: 99%

Unusual Headache Syndromes

Queiroz

2013

Headache

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“…Patients rarely experience any accompanying symptoms, and there have not been any precipitating factors identified in studies to date . Studies thus far have identified response among patients to treatment with NSAIDS – including indomethacin7‐9 – as well as with gabapentin,6,10‐12 botulinum toxin, carbamazepine, tricyclic antidepressants, and neurotropin . Recent studies utilizing transcutaneous electrical nerve stimulation have also been reported to be effective .…”

Section: Discussionmentioning

confidence: 99%