Nummular headache

Abstract

Nummular headache is a rare primary headache disorder characterized by focal and well-circumscribed pain fixed within a round-, oval-, or elliptical-shaped region of the head. The pain is usually mild to moderate in intensity but may be severe. Nummular headache is most common in women in the fourth to fifth decade of life. The temporal pattern may be chronic and continuous since onset, chronic evolved from episodic, or episodic. These headaches typically are unilateral, side-locked, and fixed in location, commonly affecting the parietal region. Many patients experience superimposed exacerbations of pain, lasting from seconds to days. Sensory phenomena, such as paresthesias, allodynia, and dysesthesias, are frequently reported in the region of the pain. Treatment with gabapentin, tricyclic antidepressants, or botulinum toxin may be helpful.

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

“…The shape of the area of NH pain in this patient was circular, did not change in form and had a diameter that measured approximately 8 cm. The intensity of pain was severe, which was similar to the cases already reported (3,4,8,13,14,19,25,26), although it is worth noting that NH pain is typically described as mild to moderate (18,23). The majority of the pain quality of NH has been described as pressing, burning or dull (8,11,19,23,24,26,29,32).…”

Nummular headache associated with focal hair heterochromia in a child

“…Symptomatic NH has been reported in association with intracranial lesions including meningiomas, after local neurosurgery, fusiform aneurysms and arachnoid cysts, and skull lesions (9)(10)(11)(12). Local ectodermal changes, including alopecia, hair loss and skin discolouration, have been noted in roughly 10% of patients (3,7). Hypothesised mechanisms linking to NH with local ectodermal abnormalities include neuropathy of a terminal branch of a cutaneous scalp nerve and focal nociceptive pain stemming from epicranial tissues (5,13).…”

Nummular headache: Six new cases and lancinating pain attacks as possible manifestation

“…However, it has been noted before that both baseline pain and exacerbations can be severe (1,3,6) and most cases of the paroxysmal form (without baseline pain) reported so far have been of severe intensity (11,12). In the present case series, all four patients suffering from electric-shock-like pain had severe pain.…”

“…This view is reflected in the current version of the research diagnostic criteria for nummular headache (Table 1) (2) and seems to apply to a majority of patients (6-9). However, some patients have been reported to suffer from pain attacks, usually lasting minutes to hours, without underlying baseline pain (10)(11)(12). In the present case series, two patients had continuous baseline pain, whereas four had pain attacks, lasting seconds to hours, without baseline pain.…”

“…Although baseline pain in nummular headache has mostly been described as pressing, burning, or dull (1,3,4,6,(8)(9)(10)12) and sometimes as stabbing or throbbing (1,3,6,11,12), it has been noted that exacerbations may be lancinating (1). Lancinating, electric-shock-like pain like that encountered in trigeminal or occipital neuralgia is a distinct, very intense type of pain that lasts only for seconds or occurs in series that may last up to a few minutes.…”