Pressure pain sensitivity of the scalp in patients with nummular headache: A cartographic study

Abstract

Nummular headache (NH) is characterized by focal pain fixed within a small round or elliptical area of the head surface. Sensory dysfunction is apparently restricted to the symptomatic area, but a thorough analysis of cranial pain sensitivity has not been performed. Pressure pain sensitivity maps were constructed for 21 patients with NH and 21 matched healthy controls. In each subject pressure pain thresholds (PPT) were measured on 21 points distributed over the scalp. In each patient PPT were also measured in the symptomatic area and at a non-symptomatic symmetrical point. In both groups an anterior to posterior gradient was found on each side, with no significant differences of PPT measurements between sides or groups. In patients with NH, only the symptomatic area showed a local decrease of PPT (significant in comparison with the non-symptomatic symmetrical point, P < 0.001). These findings further support that NH is a non-generalized disorder with a peripheral source.

Epicrania fugax with backward radiation: clinical characteristics of nine new cases

“…Eight of our patients (two in BREF and six in FREF groups) had a nummular type head pain in the stemming area between EF paroxysms, as it has been previously described [3, 14]. EF and NH probably share a peripheral source in their pathogenesis [15]. …”

Topographical pressure pain sensitivity maps of the shoulder region in individuals with subacromial pain syndrome

“…These studies revealed that mechanical sensitivity depicted by assessing pressure pain thresholds (PPTs) is not uniformly distributed around the same muscle (Fern andez-delas-Peñas et al, 2008;Ge et al, 2008) or around an anatomical area, e.g., the elbow (Ruiz_Ruiz et al, 2011), the hand (Fern andez-de-las- Peñas et al, 2010b) or the head (Cuadrado et al, 2010). Furthermore, increased mechanical sensitivity can also occur on the nonaffected side as a sign of central sensitization .…”

“…A number of studies have proposed the utility of topographical pain sensitivity maps as an exploratory method allowing spatial assessment of sensitization mechanisms in several chronic pain disorders, e.g., lateral epicondylalgia (Ruiz_Ruiz et al, 2011), carpal tunnel syndrome (Fern andez-de-las-Peñas et al, 2010b), headaches Cuadrado et al, 2010), migraine (Fern andez-de-las-Peñas et al, 2009, 2010a, shoulder pain or work-related musculoskeletal disorders (Binderup et al, 2011). These studies revealed that mechanical sensitivity depicted by assessing pressure pain thresholds (PPTs) is not uniformly distributed around the same muscle (Fern andez-delas-Peñas et al, 2008;Ge et al, 2008) or around an anatomical area, e.g., the elbow (Ruiz_Ruiz et al, 2011), the hand (Fern andez-de-las- Peñas et al, 2010b) or the head (Cuadrado et al, 2010).…”

A high prevalence of autoimmune indices and disorders in primary nummular headache

“…In NH, the painful area is generally located at the parietal area which is innervated by the ophthalmic branch of trigeminal nerve. A consistent location, size and shape [1,2], as well as allodynia and focal paresthesia [3,5] and trophic change [3,4], of the painful area rationally point to an involvement of the terminal endings in the epicranial tissue in NH. Since autoimmune disorders can cause sensory distal neuropathy, NH can be explained as a form of autoimmune-mediated epicranial painful neuropathy.…”

“…Currently, it is categorized as a primary headache in the International Classification of Headache Disorders, second edition [2]. NH is proposed a form of peripheral neuralgia of the trigeminal nerve [3] which is supported by the consistency of pain pattern, focal atrophic change [4], and local sensory alteration [5] within the painful area. Although intracranial secondaries [6][7][8] and previous focal trauma [9] have been found in a few NH patients, the etiopathogenesis of NH is factually unknown.…”