Nummular Headache - a Case Report of a Rare Entity

Abstract

Background: Nummular Headache is a rare type of chronic primary headache wherein the pain is usually located in a well-circumscribed, round or elliptical shaped area of the scalp. Case Report: A 26-year-old female presented to the Center for TMD/ OFP with the chief complaint of chronic persistent left parietal headache, for more than 10 years, which has been worsening over the past few days with no specific identifiable trigger. The medical history is non-contributory. The primary diagnosis is Nummular Headache. Conclusion: A comprehensive history is the first step to achieve an accurate diagnosis. The diagnosis of Nummular Headache is challenging and confusing due to the rare occurrence. An examination must include imaging and is detrimental in eliminating other underlying pathologies. The diagnosis is made from distinct clinical features after exclusion of all other entities.

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

“…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]. These results could indeed be due to a publication bias, with positive studies more likely to report the clinical benefit; further, only two large series have been published in the literature so far [5,6].…”

The Tricky Diagnosis of Nummular Headaches: Description of Two Cases and Literature Review

“…Although some show promising results, no single therapy has given a complete resolution of symptoms [ 6 ]. Furthermore, therapeutic intervention is not always necessary and may only require simple reassurance [ 13 ].…”

Epicranial headaches part 2: Nummular headache and epicrania fugax

“…In addition to spontaneous pain, there may be sensory disturbances in the affected area. The description given for these disturbances is diverse, but in one form or another they can be found in many cases of NH (1,4,6,(10)(11)(12)(13)(14)16,(20)(21)(22)(23)(24)(25)(26)(27)29,31,35,39,41,42,47,48,51,53,(57)(58)(59)(60)(63)(64)(65)(66). In one of the largest series, sensory symptoms or signs were detected in more than 40% of cases (33).…”

“…Normally the pain affects one of the two sides of the head; however, more than 50 cases have been reported with the painful area over the midline (4,6,7,9,15,24,32,37,55,58,59,62,65). Thirty-six patients have also been reported with bifocal NH, with two separate areas of pain (22,23,30,32,34,38,58,60). In these cases, the temporal sequence has been heterogeneous, either migratory (with transfer of symptoms from one area to another), additive (with aggregation of symptomatic areas) or synchronous (with simultaneous evolution of symptoms in all locations) (22,32).…”

“…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).…”