Can Temporal Course of Pain Determine Patient Response to Specific Medication in Nummular Headache?

Kurian, Michelle M; Solomon, Glen D.

doi:10.1111/head.12331

Cited by 9 publications

(5 citation statements)

References 15 publications

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“…Gabapentin is the oral preventive drug with most available evidence in the treatment of primary NH. Case reports and case series have shown pain disappearance in 27/43 (40%) [5,[23][24][25][26][27][28] of NH patients treated with gabapentin. Improvement in the intensity of pain was found in 18/39 (46%) patients [5,25,29,30], while no response was reported in 5/6 (83%) patients [21,30,31] and lack of tolerability in 1 additional case [32].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Primary Nummular Headache: A Series of 183 Patients from the NUMITOR Study

García-Iglesias

Puledda

Echavarría-Íñiguez

et al. 2022

JCM

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Nummular headache (NH) is a primary headache characterized by superficial coin-shaped pain. NUMITOR (NCT 05475769) is an observational study evaluating the responder rate of preventive drugs in NH patients. The treatment response was assessed between weeks 8 and 12 compared with the baseline. Patients were included between February 2002 and October 2022. Demographic and clinical variables were assessed; treatment response was estimated by 50%, 30%, and 75% responder rates and treatment discontinuation due to inadequate tolerability. A total of 183 out of 282 patients fulfilled eligibility criteria and completed the study. Patients were aged 49.5 (standard deviation (SD): 16.8) years, and 60.7% were female. NH phenotype was a parietal circular pain of four centimeters’ diameter, moderate intensity, and oppressive quality. At baseline, patients had 25 (interquartile range) pain days per month. Preventive treatment was used by 114 (62.3%) patients. The highest 50% and 75% responder rates corresponded to onabotulinumtoxinA (62.5%, 47.5%), followed by gabapentin (43.7%, 35.2%). Oral preventive drugs were not tolerated by 12.9–25%. The present study provides class IV evidence of the effectiveness of oral preventive drugs and onabotulinumtoxinA in the treatment of primary NH. OnabotulinumtoxinA was the most effective and best-tolerated drug, positioning it as first-line treatment of NH.

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Section: Discussionmentioning

confidence: 99%

Treatment of Primary Nummular Headache: A Series of 183 Patients from the NUMITOR Study

García-Iglesias

Puledda

Echavarría-Íñiguez

et al. 2022

JCM

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“…NH may be considered an unusual type of headache, but it is not exceptional. To date, about 540 different cases have been described in full-length papers, with some of these cases being included in more than one paper (1,4–66). The gender distribution has shown a female predominance, with a ratio of 1.6:1.…”

Section: Nummular Headachementioning

confidence: 99%

“…Among oral preventives, the most widely used drug has been gabapentin (6,8,11,14,21,23,32,35,42,46,50,54,55,58–60,62,64,65), with a response rate of over 60%; the response rate appears to be most favorable at medium doses, around 800 mg/day, while low doses may not be sufficient and high doses may not be well tolerated (58). Tricyclic antidepressants can also be used as an alternative to gabapentin, but results are less consistent; beneficial effects have occasionally been obtained with amitriptyline (15,21,58,59,62,64), nortriptyline (12,62) and clomipramine (17).…”

Section: Nummular Headachementioning

confidence: 99%

Epicranial headaches part 2: Nummular headache and epicrania fugax

Cuadrado

2023

Cephalalgia

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Background Nummular headache and epicrania fugax are two primary headaches that fall under the heading of epicranial headaches. Methods This article reviews the epidemiological and clinical features of nummular headache and epicrania fugax, proposed pathogenic mechanisms and state-of-the-art management, according to the literature. Results and conclusions Nummular headache and epicrania fugax are generally viewed as rare headache disorders, but no population-based epidemiological data are available. Nummular headache is characterized by continuous or intermittent head pain, which remains circumscribed in a round or oval area of the scalp, typically one to six centimeters in diameter. Epicrania fugax manifests with brief paroxysms of pain that move along the surface of the head, following a linear or zigzag trajectory through different nerve territories. Nummular headache and epicrania fugax are mostly primary headaches, but some secondary cases have been reported. The pathogenesis of these headaches is not fully understood. Nummular headache could probably originate in epicranial tissues or adjacent intracranial structures, while the origin of epicrania fugax could be extracranial or intracranial. Diagnostic assessment requires careful examination of the symptomatic areas. Underlying disorders should be excluded by additional investigations, including neuroimaging and appropriate blood tests. No controlled clinical trials have been conducted in nummular headache or epicrania fugax. Analgesics and anti-inflammatory drugs, botulinum toxin and gabapentin are currently the most recommended treatment options for nummular headache. In epicrania fugax, the most used treatments are gabapentin, lamotrigine, and other antiseizure medications.

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“…11 So far there is little evidence for the treatment of this disorder. 12 While most publications mention therapeutic response to neuromodulators, 8,[12][13][14][15] there are also reports of improvement with onabotulinumtoxinA. [16][17][18][19] We describe a new series of patients with NH highlighting three features: (1) its frequent association with other headaches, often preceding NH for several years and sometimes affecting the same anatomical region; (2) its preferred localization to regions of the scalp with hair, which seems to be the large majority in published cases, and (3) its response to onabotulinumtoxinA.…”

Section: Introductionmentioning

confidence: 99%

“…So far there is little evidence for the treatment of this disorder. 12 While most publications mention therapeutic response to neuromodulators, 8,12 –15 there are also reports of improvement with onabotulinumtoxinA. 16 –19…”

Section: Introductionmentioning

confidence: 99%

Nummular headache

Martins

Abreu

2018

Cephalalgia Reports

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Nummular headache (NH) is an unusual disorder attributed to a dysfunction of the epicranial nerves. We report a new series of cases, highlighting some clinical features, the association with other headaches, and the therapeutic response. Data of patients with NH, fulfilling ICHD-3 criteria, observed in a Headache Outpatient clinic during 5 years, were retrieved from records. Response to onabotulinumtoxinA was recorded prospectively and evaluated with a Headache Impact Test (HIT). Twenty-four patients, aged 53.8 (+14.6) years at diagnosis, 13 women, had definitive (N ¼ 21) or probable (N ¼ 3) NH for an average of 2.4 years. Headache was consistently localized, more frequently extratrigeminal (N ¼ 15) and parietal, and confined to the scalp. Pain was unremitting since onset in 58.3% of mild-to-moderate severity often with superimposed paroxysms (66.7%) and local allodynia (70.8%). In five cases, there was a possible precipitant. Thirteen patients reported other headaches, preceding NH by 8.2 years. In eight persistent cases, there was a significant improvement on HIT, after onabotulinumtoxinA. Despite its persistence, NH may go unrecognized for years. It often follows other headache types and has some tropism for hair-covered regions of the scalp. OnabotulinumtoxinA seems effective in persistent cases.

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Can Temporal Course of Pain Determine Patient Response to Specific Medication in Nummular Headache?

Cited by 9 publications

References 15 publications

Treatment of Primary Nummular Headache: A Series of 183 Patients from the NUMITOR Study

Treatment of Primary Nummular Headache: A Series of 183 Patients from the NUMITOR Study

Epicranial headaches part 2: Nummular headache and epicrania fugax

Nummular headache

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