Bifocal Nummular Headache: The First Three Cases

Abstract

Nummular headache (NH) has been defined as a focal head pain that is exclusively felt in a small area of the head surface. Here we describe three patients who presented with focal head pain in two separate areas. This finding seems to be consistent with bifocal NH and further enlarges the clinical diversity of this headache disorder. The pathogenic mechanisms of NH may be active in multiple cranial areas in some particular patients.

The Heterogeneity of New Daily Persistent Headache

“…NH should be easily diagnosed by its cranial geography. However, an increasing number of cases of bifocal NH have recently been reported, where patients may have 2 circumscribed areas of head pain that may be continuous, and in some patients, the pain may start synchronously in both sites . If the patient or examiner does not recognize the discrete geographical confinement of the cranial pain sites in a patient with NH, it is conceivable that NDPH would be diagnosed instead.…”

Unusual Headache Syndromes

“…Most patients also describe a combination of hypoesthesia, hyperesthesia, dysesthesia, tenderness, and/or touch‐evoked paresthesias . The pain is usually unifocal, but bifocal and even multifocal cases have been reported . Patients, when explaining their symptoms, usually finger point to a specific area of the head.…”

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

“…The symptomatic areas may be located on one side or both sides of the head. The pain may emerge at the same time or follow a different course in each of the affected areas (7). Some patients have shown trophic changes within the painful area (25).…”