Nummular headache after trans-sphenoidal surgery: a referred pain-based headache syndrome

Abstract

Nummular headache (NH) is a newly categorized primary headache characterized by a consistent location, shape and size of painful area in each attack. The etiopathogenesis is entirely unknown. Currently, the peripheral theory of epicranial neuralgia is accepted more widely than the central theory but it cannot fully explain the clinical picture. We report a patient who suffered from a relapsing and remitting course of NH at the high parietal area and vertex shortly after resection for pituitary prolactinoma via a trans-sphenoidal approach. There was no focal trophic change or paresthesia but a mild allodynia in the painful area. The patient did not exhibit trigeminal sensory disorder or cranial trauma thoroughly. The pain responded well to gabapentin. Therefore, physicians should be aware of postoperative NH, which is amenable to treatment. The findings in our patient support a dual mechanism of NH and suggest that central NH is a form of referred pain.

Nummular headache and pituitary lesion: A case report and literature review

“…[1415] This remote pain is recognized a form of referred pain conveyed by the trigeminosensory nerve. In previously reported three NH patients[11–13] and ours, their pain exclusively occurred at the vertex, suggesting that their pain share a common pain-referral pathway with non-NH pain. Since, NH is an uncommon painful complication in sellar disorders; other mechanism is believed to participate for its characteristic clinicographics.…”

“…Firstly, besides of the previously reported three patients and our patient associated with involvement of sellar and regional structures,[11–13] there are another three NH patients in whom intracranial secondaries are found diffusely at cerebellar tentorium,[8] high parietal cortical area,[9] and parietotemporal cortical area,[9] respectively. These intracranial secondaries are exclusively located at the ipsilateral juxtameninges and are also close to the painful area in them.…”

“…The drug response and prognosis in these two patients was not further discussed. Yin et al .,[13] reported a man in whom NH occurred shortly after trans-sphenoidal surgery for prolactinoma. The pain responded favorably to gabapentin.…”

Nummular Headache: 2 Cases With Good Beta Blocker Responses and a Narrative Review

“…Autoimmune disorders or structural lesions of the cranium, pituitary, or vasculature have been reported previously . Overly, 32% of patients had a history of brain trauma or surgery before NH development . Insect bites and varicella‐zoster virus infection were reported in individuals …”

“…15,16,[18][19][20][21][22] Overly, 32% of patients had a history of brain trauma or surgery before NH development. 10,14,17,23,24 Insect bites and varicella-zoster virus infection were reported in individuals. 12,25 Management.-Approximately half of the patients received acute therapy with a responder rate of 53.5% (83/156), but many cases did not report the clear names of analgesics.…”